Optimizing strategies in tendon tissue engineering through effective scaffold design: overview of recent advancements

Tendon injuries pose a significant global health challenge due to the poor innate healing capacity of the tissue. Current clinical interventions report limited treatment efficacy, typically resulting in a fibrotic scar that is mechanically inferior to native tissue and predisposed to future re-rupture. Tendon tissue engineering, leveraging advances of biomimetic scaffolds, offers a promising path toward functional regeneration rather than fibrotic repair. The design of these biomimetic scaffolds is a complex, interdisciplinary challenge that has evolved from a simple structural replacement to a sophisticated, bio-instructive strategy. Literature searches were conducted using PubMed, Scopus, and R Discovery with the terms "tendon tissue engineering scaffold" or "tendon regenerative medicine scaffold," and studies published between 2020 and 2025 were included. In this review, we outline four key design principles identified to enhance tissue engineering solutions constructed for tendon: 1) Biomechanical compatibility, 2) Biocompatibility and Integration, 3) Porosity and Mass Transport, and 4) Mechanobiological Stimuli. Together, these core parameters mediate the production of hierarchical, bio-instructive scaffolds that integrate cellular components, growth factors, and mechanical stimulation to produce intelligent therapeutic systems for functional, long-lasting tendon regeneration.