Bioinductive scaffold augmentation of the patellar tendon: a scoping review of indications, techniques and early...

This scoping review aimed to collate and synthesize reports of bioinductive scaffold augmentation for patellar tendon pathology, focusing on indications, surgical techniques, and early outcomes. Additionally, it aimed to contextualize these findings through the more established rotator cuff literature and consider tendon property variation to inform future research and implant development.

A scoping review was conducted in accordance with PRISMA-ScR guidance. PubMed, Embase, Scopus, and Web of Science were searched from inception to 25 December 2025 for human studies of bioinductive scaffold augmentation in patellar tendon pathology. Two reviewers screened studies and extracted data. Findings were synthesized narratively and in tables.

The search identified 633 records, with ten studies ultimately included (6 technical notes, 3 case reports, and 1 case series), published between 2019 and 2025. Across all reports, 47 patients were described (ages 17-50; 76% male where reported); most studies used scaffolds for acute patellar tendon rupture (7/10), with fewer addressing chronic tendinopathy (3/10). Augmentation was most often indicated for poor tissue quality in rupture settings, revision after re-rupture, or persistent symptoms after failed conservative management in tendinopathy. Implants comprised a bovine Achilles tendon-derived collagen scaffold (6 studies), a decellularized human dermal allograft (2), a collagen-PLLA composite scaffold (1), and an autologous platelet-rich fibrin matrix construct (1). Post-operative rehabilitation was variably reported. Reported clinical outcomes were limited but suggested some improvements in pain, functional scores and MRI appearance.

The adoption of bioinductive scaffold augmentation in patellar tendon surgery may be considered theoretically plausible. However, fundamental pre-clinical biomechanical and histological work in human(-cadaveric) models is not available at present, and longitudinal (comparative) clinical research is ultimately needed to investigate the effects of this application, and allow for the meaningful interpretation of results. The intrinsic mechanical and biological properties of the patellar tendon warrant a more nuanced consideration in technique standardization and future device iterations.