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Tendon Biology and Healing

68 citationsUpdated Oct 2026
Illustration: Tendon Biology and Healing

Overview

Tendon healing is fundamentally limited by the tissue’s lack of intrinsic regenerative capacity, resulting in the formation of fibrovascular scar tissue rather than restoration of native structure [2]. This standard healing process involves inflammatory, proliferative, and remodeling phases driven by native fibroblasts, recruited inflammatory cells, and progenitor cells [45]. Direct insertions, such as the ACL and rotator cuff, feature a fibrocartilage transition that does not regenerate when injured; consequently, repair or reconstruction produces a fibrovascular scar tissue bridge rather than a biological reattachment [45]. The ultimate goal of therapeutic intervention is to overcome this reactive scar formation and stimulate a regenerative healing pathway at the tendon-bone insertion site [6].

Understanding the biology and organization of native tendon, including morphogenesis and the parallels between tendon development and healing, is necessary to improve current treatment modalities [13]. Development of effective therapeutics has been hindered by a lack of fundamental guiding data on tendon development, signal transduction, mechanotransduction, and basic mechanisms underlying pathogenesis and healing [1]. Biochemical pathways activated during repair and experimental injury models are emphasized in the study of tendon repair and regeneration [12]. While vascularisation affects the tensile strength and rupture vulnerability of the healthy Achilles tendon, it is unlikely to be the sole or most significant contributor [63]. Furthermore, the concept that flexor tendons are nourished primarily by vascular perfusion is not supported by studies using tritiated praline in chickens [67]. The proper term for tendon degeneration without signs of inflammation is tendinosis [62].

Biologic augmentation of surgical repair is becoming increasingly widespread, with the most commonly used techniques being bone marrow aspirate concentrate (BMAC), platelet-rich plasma (PRP), and growth factors [45]. Molecular therapies targeting key elements of the healing process can be expected to favor the healing process [24], although the clinical relevance of growth factors identified in basic science reports for the practicing hand surgeon remains unclear [8]. Significant long-term harms to tendon tissue and cells are associated with glucocorticoid injections [19]. Continued research is required to discover and develop novel strategies for manipulating the various cellular, molecular, chemical, and biomechanical mediators of the healing pathway to improve clinical outcomes [45].

How It Works

Fundamental Biology and Development

Development of effective therapeutics for tendon is hindered by a lack of fundamental guiding data on tendon development, signal transduction, mechanotransduction, and basic mechanisms underlying pathogenesis and healing [1]. A greater understanding of the molecular mechanisms involved in tendon and ligament development and natural healing, coupled with the capability of producing complex biomaterials, should lead to regenerative procedures that more closely recapitulate morphogenesis [20]. The review emphasizes the challenges in tenocyte characterisation and the need for improved strategies to enhance tendon repair and regeneration [5].

Healing Mechanisms and Scar Formation

The healing process at the tendon-bone insertion site results in a reactive scar rather than a histologically normal tendon-bone insertion site [6]. Optimising tendon healing requires understanding the biological processes of inflammation, repair, and remodelling [14]. A better understanding of the balance between intrinsic and extrinsic healing processes may allow surgeons to eventually tailor their surgical procedures to best reestablish tendon continuity and function [22]. Differences in healing mechanisms reveal that extrasynovial tendons heal more effectively than intrasynovial tendons [38]. Tendon fibroblasts and macrophages participate in fibroplasia at the cut end of the tendon segment, a cellular response in accord with the tendon callus theory [35]. Tendons in vitro demonstrate active collagen synthesis and thus the capacity for autonomous repair [36]. The study demonstrates a pivotal contribution of all investigated MMPs and TIMP-1, but a minor role of TIMP-2, -3, and -4, in the early human tendon healing process [37].

Growth Factors and Molecular Pathways

The article reviews the molecular basis of flexor tendon wound healing and the role of growth factors, noting that while basic science reports have identified various factors, their clinical relevance for the practicing hand surgeon remains unclear [8]. Understanding the role that growth factors play in tendon repair should enable a more targeted approach to be developed to improve the results of flexor tendon repair, although currently no strategies are routinely used in clinical practice [16]. This review discusses the current state of knowledge of diabetic tendon healing from molecular to mechanical disruptions and identifies promising approaches and critical knowledge gaps as the field moves toward identification of novel therapeutic strategies to maintain or restore tendon function in diabetic patients [4].

Regenerative Strategies and Biologics

The ultimate goal of using biologics to improve healing of the tendon-bone insertion site after repair is to stimulate a regenerative healing pathway [6]. The current evidence shows that stem cells can have a positive effect on tendon healing, likely due to regeneration potential producing tissue similar to the preinjury state, though results can be variable [18]. This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing [15]. The development and applications of compatible biomaterials to both better recapitulate the tendon-bone interface and improve delivery of biological factors for enhanced integrative repair are highlighted [17]. These approaches involve making new combinations of materials, designs, cells, and bioactive molecules to achieve personalized regeneration of a functional tendon [21]. If data are supported by relevant clinical studies there may be a role for enhancement of the tendon-bone repair and healing process either by the alteration of collagen synthesis and maturation or by encouraging a greater bony participation in the healing process [3]. It might be beneficial for the healing of rotator cuff tendon to bone to use an octacalcium phosphate in the re-formation of infraspinatus tendon insertion [27]. This document describes the protocol for a phase I/II randomized clinical trial designed to test the hypothesis that MSC and LP-PRP will restore function, but tendon regeneration will only be observed in the MSC group [7]. In the basic science studies evaluated, it appears that PRP confers several effects on tendon healing compared with a control [11]. This review focuses on the specific molecular and cellular mechanisms by which PRP manipulates tendon healing to better understand how PRP affects tendinopathy and explore the reason for the differences in clinical trial outcomes [10].

What the Evidence Shows

Tendon Healing Biology and Pathogenesis

Development of effective therapeutics is hindered by the lack of fundamental guiding data on tendon development, signal transduction, mechanotransduction, and basic mechanisms underlying tendon pathogenesis and healing [1]. Current literature emphasizes biochemical pathways activated during repair, experimental injury models, and parallels between tendon healing and tendon development [12]. The healing process after tendon repair results in a reactive scar rather than a histologically normal tendon-bone insertion site [6]. While the ultimate goal is to stimulate a regenerative healing pathway, no novel biologic healing approach has been successful in enhancing healing of the injured enthesis [44]. Reviews summarize the basic biology of tendon tissues and provide updates on the latest repair proposals for tendon tears [9], while critically reviewing the immunobiological responses following rotator cuff lesions and the inherent repair mechanisms elicited by the body [72].

Mechanical Loading and Rehabilitation

Early controlled motion after flexor tendon repair has a favorable effect on the healing and remodeling response, resulting in stronger repairs and enabling greater excursion of the repaired tendon [40]. Early controlled passive motion does not interfere with the rate of early flexor tendon healing and may improve healing efficiency [43]. This approach stimulates an intrinsic healing response, restores the gliding surface at an early stage, and results in a repair that is mechanically stronger and structurally more similar to the normal tendon-sheath interface compared to immobilization [54]. Numerous randomized controlled trials have shown no difference in healing rates between early mobilization and delayed rehabilitation protocols after rotator cuff repair [39]. Delay of supraspinatus repair by up to 12 weeks does not impair enthesis formation, supporting both a trial of conservative treatment after a rotator cuff tear and a positive outcome of rotator cuff repair even if delayed by up to 12 weeks [41]. Further investigation with a focus on improving clinical outcomes is needed to determine the most suitable methods of incorporating mechanical loading findings toward improving tendon repair, including optimal timing, parameters, and application in rehabilitation and tissue engineering [33].

Biologics and Regenerative Strategies

Although many biologic therapies have achieved some degree of success in improving structural, histological, and clinical outcomes after surgical tendon-bone enthesis repair, none have reliably and consistently led to clinical improvement [30]. Biologic adjuvants have great potential to improve rotator cuff healing and reduce rates of reinjury, but current surgical treatments remain inadequate with high failure rates for large and massive tears [49]. Biological therapies facilitate the regeneration of the correct microarchitecture of the tendon attachment to the bone and reduce failures after surgical rotator cuff repair [46]. Recent incremental improvements in clinical outcomes suggest that new biologic strategies, such as cell-based strategies and tissue engineering, may be useful adjuncts to further improve current clinical outcomes in flexor tendon surgery [32]. Research in biologic modulators to promote scarless healing continues to show promise [65]. The combination of stem cells and growth factors resulted in enhanced repair that emulated uninjured tissue, but the literature search reflected paucity of research in this field [71]. Papers detail mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing [15]. One article critically reviews the potential role of exosomes in tendon regeneration and proposes the novel use of exosomes alone or seeded onto biomaterial matrices to stimulate secretion of favorable cellular factors in accelerating the healing response following rotator cuff repair [73].

Growth Factors and Molecular Mechanisms

Recent research has been focused on using pharmacologic agents to modify the healing environment to increase the healing response within the tendon while decreasing the adhesion formation between the tendon and its sheath [50]. GDF-8's treatment efficacy of the early tendon repair remains to be defined [28].

Platelet-Rich Plasma (PRP)

Compared with Lr-PRP, Lp-PRP improves tendon healing and is a preferable option for the clinical treatment of tendinopathy [64]. The primary use of glucocorticoids did not exert any obvious deleterious side effects on the treated tendon but instead enhanced the regenerative effects of platelet-rich plasma in early inflammatory tendinopathy [31].

Specific Tendon Models and Interventions

If these data are supported by relevant clinical studies there may be a role for enhancement of the tendon-bone repair and healing process either by the alteration of collagen synthesis and maturation or by encouraging a greater bony participation in the healing process [3]. The review evaluates the use of biologics to improve healing of the tendon-bone insertion site after repair, noting that while the healing process results in a reactive scar rather than a histologically normal tendon-bone insertion site, the ultimate goal is to stimulate a regenerative healing pathway [6]. Few clinical trials have examined the effect of scaffolds on tendon-bone healing in well-designed, long-term follow-up studies with appropriate control groups [26]. It might be beneficial for the healing of rotator cuff tendon to bone [27]. At 24 weeks, bone tendon interface regenerated to normal fibrocartilaginous enthesis after a primary repair of the infraspinatus in canines [51]. A DBM enhanced with MSCs can augment rotator cuff healing at 6 weeks and restore bone mineral density at the enthesis to its preinjury levels [56]. The control group demonstrated a similar outcome to augmented repairs in a chronic rotator cuff tear model using demineralized cortical bone matrix [48]. Co-administration of atelocollagen and HA improves healing of the rotator cuff and increases the integrity of the rotator cuff repair site [57]. At the first and fifth week after the operation, there was no significant difference between tendon growth in the control group and that in the grafted group [47]. This review supports the emerging clinical evidence that shows significant long-term harms to tendon tissue and cells associated with glucocorticoid injections [19]. Current treatments with the highest evidence entail non-surgical methods to promote tendon healing with focused eccentric exercises and biophysical procedures [52]. There is a large body of evidence addressing treatment of acute and chronic Achilles tendon ruptures; however, controversy remains [29]. The review synthesizes literature to address historical controversies and evolving research in primary flexor tendon repair [23]. The paper reviews challenges and opportunities for developing effective treatment strategies for enthesis repair, highlighting the need for better understanding of disease pathoetiology, improved outcome measures, and well-designed clinical trials to test repair augmentation strategies [25].

Practical Considerations

Biological Limitations and Healing Mechanisms

Tendon healing produces a reactive scar rather than a histologically normal tendon-bone insertion site [6]. Primary repair remains the standard of care, yet repaired tendon tissue rarely achieves functionality equal to that of the preinjured state [58]. Improving current treatment modalities requires a fundamental understanding of native tendon biology, organization, and the morphogenesis of tendon tissue [13].

Biologics and Augmentation Strategies

Biomaterials: The development of compatible biomaterials that better recapitulate the tendon-bone interface and improve the delivery of biological factors for enhanced integrative repair is a key area of focus [17].

Cellular and Growth Factor Therapies: Autologous tenocyte injection (ATI) represents a safe and valuable second-line option for chronic, resistant tendinopathies, with a minimal risk of side effects [61]. The treatment efficacy of Growth Differentiation Factor 8 (Myostatin) in early tendon repair remains to be defined [28]. While basic science reports have identified various growth factors for flexor tendon wound healing, their clinical relevance for the practicing hand surgeon remains unclear [8]. In basic science studies, platelet-rich plasma (PRP) confers several effects on tendon healing compared with a control [11]. A phase I/II randomized clinical trial protocol was designed to test the hypothesis that mesenchymal stem cells (MSC) and LP-PRP will restore function, with tendon regeneration expected only in the MSC group [7].

Glucocorticoids: The primary use of glucocorticoids did not exert any obvious deleterious side effects on the treated tendon but instead enhanced the regenerative effects of platelet-rich plasma in early inflammatory tendinopathy in a rabbit model [31]. Conversely, a systematic review supports emerging clinical evidence that shows significant long-term harms to tendon tissue and cells associated with glucocorticoid injections [19].

Mechanical Loading and Rehabilitation

No specific evidence regarding mechanical loading or rehabilitation protocols is provided in the current evidence base for this section.

Specific Pathologies and Surgical Techniques

Musculotendinous Junction Tears: The described surgical technique preserves tendon length, avoids excess tension, and preserves the enthesis, resulting in tendon-to-tendon healing and avoiding cut-through [60].

Tenolysis and Harvesting: The modified 69 blade for tenolysis is a very sharp blade and requires careful use to prevent fraying of the tendon [55]. The technique for harvesting the palmaris longus tendon allows the tendon to be harvested with minimal scarring [59].

Tissue Engineering and Cost-Effectiveness: Generating tissue engineered tendon constructs can be of considerable clinical benefit given the lack of adequate intrasynovial tendon graft sources, donor site morbidity, and the propensity for current methods of repair to cause adhesion formation [53]. Rotator cuff repair is cost-effective for all populations [42].

Key Evidence

  • [L5] Development of effective therapeutics is hindered by the lack of fundamental guiding data on the biology of tendon development, signal transduction, mechanotransduction and basic mechanisms underlying tendon pathogenesis and healing. [1] (10.1002/jor.22869)
  • [L5] Tendon healing is characterized by the formation of fibrovascular scar tissue, as tendon has very little intrinsic regenerative capacity. [2] (10.1002/jor.22853)
  • [L5] If these data are supported by relevant clinical studies there may be a role for enhancement of the tendon-bone repair and healing process either by the alteration of collagen synthesis and maturation or by encouraging a greater bony participation in the healing process. [3] (10.1053/jhsu.2003.50091)
  • [L5] The review emphasizes the challenges in tenocyte characterisation and the need for improved strategies to enhance tendon repair and regeneration. [5] (10.1089/ten.teb.2016.0181)
  • [Paper] The review evaluates the use of biologics to improve healing of the tendon-bone insertion site after repair, noting that while the healing process results in a reactive scar rather than a histologically normal tendon-bone insertion site, the ultimate goal is to stimulate a regenerative healing pathway. [6] (10.1016/j.csm.2012.07.003)
  • [L2] This document describes the protocol for a phase I/II randomized clinical trial designed to test the hypothesis that MSC and LP-PRP will restore function, but tendon regeneration will only be observed in the MSC group. [7] (10.1186/s13018-019-1477-2)
  • [L5] The article reviews the molecular basis of flexor tendon wound healing and the role of growth factors, noting that while basic science reports have identified various factors, their clinical relevance for the practicing hand surgeon remains unclear. [8] (10.1016/j.jhsa.2004.04.020)
  • [L4] The review summarizes the basic biology of tendon tissues and provides an update on the latest repair proposals for tendon tears. [9] (10.1302/2058-5241.2.160075)
  • [L4] This review focuses on the specific molecular and cellular mechanisms by which PRP manipulates tendon healing to better understand how PRP affects tendinopathy and explore the reason for the differences in clinical trial outcomes. [10] (10.3389/fbioe.2023.1187974)
  • [L1] In the basic science studies evaluated, it appears that PRP confers several effects on tendon healing compared with a control. [11] (10.1016/j.arthro.2013.07.117)
  • [L5] Biochemical pathways activated during repair, experimental injury models, and parallels between tendon healing and tendon development are emphasized. [12] (10.1146/annurev-bioeng-071811-150122)
  • [L5] Understanding the biology and organization of the native tendon and the process of morphogenesis of tendon tissue is necessary to improve current treatment modalities. [13] (10.1016/j.jhsa.2007.09.007)
  • [L5] Optimising tendon healing requires understanding the biological processes of inflammation, repair, and remodelling. [14] (10.1136/bjsm.36.5.315)
  • [L5] This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing. [15] (10.1002/jor.24475)
  • [L5] Understanding the role that growth factors play in tendon repair should enable a more targeted approach to be developed to improve the results of flexor tendon repair, although currently no strategies are routinely used in clinical practice. [16] (10.1177/1753193413509231)
  • [L4] Finally, the development and applications of compatible biomaterials to both better recapitulate the tendon-bone interface and improve delivery of biological factors for enhanced integrative repair are highlighted. [17] (10.1111/nyas.13267)
  • [L4] The current evidence shows that stem cells can have a positive effect on tendon healing, likely due to regeneration potential producing tissue similar to the preinjury state, though results can be variable. [18] (10.1016/j.arthro.2011.12.009)
  • [L4] This review supports the emerging clinical evidence that shows significant long-term harms to tendon tissue and cells associated with glucocorticoid injections. [19] (10.1016/j.semarthrit.2013.08.006)
  • [L5] A greater understanding of the molecular mechanisms involved in tendon and ligament development and natural healing, coupled with the capability of producing complex biomaterials, should lead to regenerative procedures that more closely recapitulate morphogenesis. [20] (10.1002/bdrc.21041)
  • [L5] These approaches involve making new combinations of materials, designs, cells, and bioactive molecules to achieve personalized regeneration of a functional tendon. [21] (10.1016/j.jconrel.2021.03.040)
  • [L4] A better understanding of the balance between intrinsic and extrinsic healing processes may allow surgeons to eventually tailor their surgical procedures to best reestablish tendon continuity and function. [22] (10.1016/j.jbiomech.2003.11.005)
  • [L4] The review synthesizes literature to address historical controversies and evolving research in primary flexor tendon repair. [23] (10.4081/or.2015.6125)
  • [L5] The paper reviews challenges and opportunities for developing effective treatment strategies for enthesis repair, highlighting the need for better understanding of disease pathoetiology, improved outcome measures, and well-designed clinical trials to test repair augmentation strategies. [25] (10.2106/jbjs.18.00200)
  • [L4] Few clinical trials have examined the effect of scaffolds on tendon-bone healing in well-designed, long-term follow-up studies with appropriate control groups. [26] (10.1177/2325967115587495)
  • [L5] It might be beneficial for the healing of rotator cuff tendon to bone. [27] (10.1016/j.jse.2015.01.011)
  • [L5] GDF-8's treatment efficacy of the early tendon repair remains to be defined. [28] (10.1177/1558944718792708)
  • [L5] There is a large body of evidence addressing treatment of acute and chronic Achilles tendon ruptures; however, controversy remains. [29] (10.2106/jbjs.o.00002)
  • [L4] Although many biologic therapies have achieved some degree of success in improving structural, histological, and clinical outcomes after surgical tendon-bone enthesis repair, none have reliably and consistently led to clinical improvement. [30] (10.5435/jaaos-d-20-01011)
  • [L5] The primary use of glucocorticoids did not exert any obvious deleterious side effects on the treated tendon but instead enhanced the regenerative effects of platelet-rich plasma in early inflammatory tendinopathy. [31] (10.1177/03635465211037354)
  • [L5] Recent incremental improvements in clinical outcomes suggest that new biologic strategies, such as cell-based strategies and tissue engineering, may be useful adjuncts to further improve current clinical outcomes in flexor tendon surgery. [32] (10.1016/j.hcl.2005.01.001)
  • [L5] Further investigation with a focus on improving clinical outcomes is needed to determine the most suitable methods of incorporating mechanical loading findings toward improving tendon repair, including optimal timing, parameters, and application in rehabilitation and tissue engineering. [33] (10.2106/jbjs.l.01004)
  • [L5] This cellular response is in accord with the tendon callus theory, as tendon fibroblasts and macrophages participate in fibroplasia at the cut end of the tendon segment. [35] (10.1016/0363-5023(89)90060-9)
  • [Paper] Tendons in vitro demonstrate active collagen synthesis and thus the capacity for autonomous repair. [36] (10.1016/s0363-5023(88)80127-8)
  • [L4] The study demonstrates a pivotal contribution of all investigated MMPs and TIMP-1, but a minor role of TIMP-2, -3, and -4, in the early human tendon healing process. [37] (10.3390/ijms18102199)
  • [L5] These differences reveal mechanisms through which extrasynovial tendons heal more effectively than do intrasynovial tendons. [38] (10.2106/jbjs.20.01253)
  • [L2] Numerous randomized controlled trials have shown no difference in healing rates between early mobilization and delayed rehabilitation protocols. [39] (10.1016/j.ocl.2015.08.017)
  • [L5] Early controlled motion after flexor tendon repair has a favorable effect on the healing and remodeling response, resulting in stronger repairs and enabling greater excursion of the repaired tendon. [40] (10.1016/s0749-0712(21)00284-5)
  • [L3] These results support both a trial of conservative treatment after a rotator cuff tear and a positive outcome of rotator cuff repair even if delayed by up to 12 weeks. [41] (10.1002/jor.20031)
  • [L4] Rotator cuff repair is cost-effective for all populations. [42] (10.2106/jbjs.l.01495)
  • [L3] These findings suggest that early controlled passive motion does not interfere with the rate of early flexor tendon healing and may improve healing efficiency. [43] (10.1016/s0363-5023(09)91107-8)
  • [L5] No novel biologic healing approach has been successful in enhancing healing of the injured enthesis. [44] (10.1016/j.jse.2017.10.030)
  • [L2] Biological therapies facilitate the regeneration of the correct microarchitecture of the tendon attachment to the bone and reduce failures after surgical rotator cuff repair. [46] (10.1530/eor-24-0012)
  • [Paper] At the first and fifth week after the operation, there was no significant difference between tendon growth in the control group and that in the grafted group. [47] (10.1016/s0363-5023(88)80056-x)
  • [L5] The control group demonstrated a similar outcome to augmented repairs. [48] (10.1016/j.jse.2017.01.003)
  • [L5] Biologic adjuvants have great potential to improve rotator cuff healing and reduce rates of reinjury, but current surgical treatments remain inadequate with high failure rates for large and massive tears. [49] (10.1177/2325967116636586)
  • [L5] Recent research has been focused on using pharmacologic agents to modify the healing environment to increase the healing response within the tendon while decreasing the adhesion formation between the tendon and its sheath. [50] (10.1016/j.ocl.2015.08.019)
  • [Paper] At 24 weeks, bone tendon interface regenerated to normal fibrocartilaginous enthesis. [51] (10.1016/s1058-2746(98)90107-0)
  • [L5] Current treatments with the highest evidence entail non-surgical methods to promote tendon healing with focused eccentric exercises and biophysical procedures. [52] (10.1136/jisakos-2018-000202)
  • [L5] Generating tissue engineered tendon constructs can be of considerable clinical benefit given the lack of adequate intrasynovial tendon graft sources, donor site morbidity, and the propensity for current methods of repair to cause adhesion formation, though this requires careful consideration of key aspects of developing a functional, durable, and biocompatible scaffold. [53] (10.1177/1753193413512432)
  • [L5] Early controlled passive motion stimulates an intrinsic healing response, restores the gliding surface at an early stage, and results in a repair that is mechanically stronger and structurally more similar to the normal tendon-sheath interface compared to immobilization. [54] (10.2106/00004623-198365010-00010)
  • [L5] The disadvantages are that it is a very sharp blade and requires careful use to prevent fraying of the tendon. [55] (10.1016/s0363-5023(83)80138-5)
  • [L5] A DBM enhanced with MSCs can augment rotator cuff healing at 6 weeks and restore bone mineral density at the enthesis to its preinjury levels. [56] (10.1177/0363546517727512)
  • [L1] Co-administration of atelocollagen and HA improves healing of the rotator cuff and increases the integrity of the rotator cuff repair site. [57] (10.5397/cise.2021.00234)
  • [L5] Primary repair remains the standard of care, but repaired tendon tissue rarely achieves functionality equal to that of the preinjured state. [58] (10.5435/00124635-201103000-00002)
  • [L4] This technique allows the tendon to be harvested with minimal scarring. [59] (10.1016/0266-7681(93)90008-4)
  • [Paper] The described technique preserves the tendon length, avoids excess tension, and preserves the enthesis, resulting in tendon-to-tendon healing and avoiding cut-through. [60] (10.1016/j.eats.2016.09.001)
  • [L4] Autologous tenocyte injection (ATI) might represent a safe and valuable option in the management of chronic tendinopathies as a second line treatment in the case of resistant tendinopathies, with a minimal risk of side effects. [61] (10.3390/jfmk10010095)
  • [Paper] The proper term for tendon degeneration without signs of inflammation is tendinosis. [62] (10.1016/s0278-5919(05)70266-0)
  • [L5] Whilst no definitive conclusion was reached, it was concluded that the vascularisation does affect the tensile strength and so rupture vulnerability of the healthy Achilles tendon, although it is unlikely to be either the sole, or most significant, contributor. [63] (10.1016/j.injury.2005.02.012)
  • [L5] Compared with Lr-PRP, Lp-PRP improves tendon healing and is a preferable option for the clinical treatment of tendinopathy. [64] (10.1177/0363546517694357)
  • [L5] Research in biologic modulators to promote scarless healing continues to show promise. [65] (10.1016/j.hcl.2014.12.004)
  • [Paper] The concept that flexor tendons are nourished primarily by vascular perfusion is not supported by these studies. [67] (10.1016/s0363-5023(78)80036-7)
  • [L4] The combination of stem cells and growth factors resulted in enhanced repair that emulated uninjured tissue, but the literature search reflected paucity of research in this field. [71] (10.1016/j.jse.2011.10.004)
  • [L5] The article critically reviews the immunobiological responses following rotator cuff lesions and the inherent repair mechanisms elicited by the body. [72] (10.1007/s11010-016-2710-5)
  • [L4] This article critically reviews the potential role of exosomes in tendon regeneration and proposes the novel use of exosomes alone or seeded onto biomaterial matrices to stimulate secretion of favorable cellular factors in accelerating the healing response following rotator cuff repair. [73] (10.1007/s00774-019-01013-z)

References

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[2] Tendon regeneration and scar formation: The concept of scarless healing. Journal of Orthopaedic Research. 2015. DOI: 10.1002/jor.22853

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[15] Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration. Journal of Orthopaedic Research. 2019. DOI: 10.1002/jor.24475

[16] The growth factors involved in flexor tendon repair and adhesion formation. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413509231

[17] Advances in biologic augmentation for rotator cuff repair. Annals of the New York Academy of Sciences. 2016. DOI: 10.1111/nyas.13267

[18] Exploring the Application of Stem Cells in Tendon Repair and Regeneration. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2011.12.009

[19] The risks and benefits of glucocorticoid treatment for tendinopathy: A systematic review of the effects of local glucocorticoid on tendon. Seminars in Arthritis and Rheumatism. 2014. DOI: 10.1016/j.semarthrit.2013.08.006

[20] Tendon and ligament regeneration and repair: Clinical relevance and developmental paradigm. Birth Defects Research Part C: Embryo Today: Reviews. 2013. DOI: 10.1002/bdrc.21041

[21] Tendon tissue engineering: Cells, growth factors, scaffolds and production techniques. Journal of Controlled Release. 2021. DOI: 10.1016/j.jconrel.2021.03.040

[22] Biomechanics of tendon injury and repair. Journal of Biomechanics. 2004. DOI: 10.1016/j.jbiomech.2003.11.005

[23] A review of current concepts in flexor tendon repair: physiology, biomechanics, surgical technique and rehabilitation.. Orthopedic Review. 2015. DOI: 10.4081/or.2015.6125

[24] Molecular_Events_of_Cellular_Apoptosis_and_Proliferation_in_the_Early_Tendon_Hea_S0363502310000791. n.d..

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