Biologic augmentation of tendon-to-bone healing: scaffolds, mechanical load, vitamin D, and diabetes

Biologic and synthetic scaffolds, mechanical loads, vitamin D, and diabetes can affect tendon and tendon-to-bone healing, muscle recovery, and growth in the perioperative period. Despite important advances in technical approaches to achieve surgical repair of soft tissues in a minimally invasive fashion, structural healing after tendon-to-bone repair remains a formidable challenge that is complicated by our incomplete knowledge of complex natural biologic processes and a diverse patient population with various comorbidities and deficiencies. Scientific research has led to promising strategies for promoting a structural repair that recapitulates the native anatomy of the tendon or enthesis. Augmentation with scaffolds may reinforce the initial repair biomechanically and can be coupled with growth factors to promote a favorable biologic environment for healing. Careful consideration of the implications of postoperative rehabilitation and endocrine and nutritional deficiencies on structural healing and muscle recovery are also critical to optimize patient outcomes.