Decellularized and Engineered Tendons as Biological Substitutes: A Critical Review

Area of Science:

• Orthopaedics
• Biomaterials Science
• Regenerative Medicine

Background:

• Tendon ruptures present significant clinical challenges, necessitating effective graft materials.
• Biological scaffolds are crucial for tendon repair, with requirements varying by application.
• Decellularized tendon-derived matrix is an emerging biomaterial for tendon substitution.

Purpose of the Study:

• To review in vitro and in vivo studies on decellularization and cell reseeding protocols for tendon matrix scaffolds.
• To identify optimal biological scaffold properties for tendon repair, particularly for the Achilles tendon.
• To assess preclinical animal models for evaluating tendon substitution devices.

Main Methods:

• Systematic review of studies on decellularization techniques (physical, chemical) and cell reseeding strategies.
• Analysis of various allogenic and xenogeneic tendon sources and specimen dimensions.
• Evaluation of cell types (differentiated, mesenchymal stem cells) and culture methods (static, dynamic).

Main Results:

• A wide range of decellularization and reseeding approaches exist for tendon scaffolds.
• Diverse tendon sources, cell types, and culture conditions are employed in preclinical studies.
• The review identified key factors influencing scaffold biomechanics and intrinsic properties.

Conclusions:

• Optimizing decellularization and cell reseeding protocols is crucial for developing effective tendon scaffolds.
• Further research is needed to translate these findings into clinical applications for tendon repair.
• Decellularized tendon matrix holds potential for future clinical use in tendon substitution, especially for the Achilles tendon.