Tendon and Ligament Tissue Engineering, Healing and Regenerative Medicine

Tendons transmit forces from muscle to bone and provide the joint function and ligaments transmit forces from bone to bone and provide joint stability. Tendon and ligament injuries have high incidence and management of tendon and ligament injuries is technically demanding because the healing response of these soft connective tissues is low. In addition, number of the available options to be considered as tissue replacement for large defects is low and healing of tendon and ligaments is faced to significant limitations. Among the available options, autografts are still gold standard but all the auto- allo and xenografts have their own limitations. Tissue engineering is a newer option but it is still primitive to be applicable extensively, in clinical setting. Tissue engineering could be divided into four categories including scaffolds, healing promotive factors, stem cells and gene therapy. To be able to have a good judgment regarding the management of tendon and ligament injuries, it is crucial to have a basic knowledge of tendon and ligament healing and regeneration. In this review, we discussed various types of tendon and ligament injuries and their incidence, and introduced the available and future options in managing large and massive tendon and ligament injuries. We specifically discussed the tissue engineering and it’s advantageous and disadvantageous. To give a better clarification for the readers, we described different phases and cascades of tendon and ligament healing, modeling and remodeling, host-graft interaction after implantation of the graft and various types of prosthetic implants and finally provided some suggestions for the future investigations.