A tissue-engineered approach to tendon and ligament reconstruction

Abstract

A tissue-engineered scaffold for use in tendon and ligament reconstruction has the potential to reduce or prevent disease transmission from allografts and diminish any potential immunologic foreign-body response associated with allograft reconstruction. In addition, the possibility of “off-the-shelf” availability of such a scaffold would eliminate the donor site morbidity, increased surgical time, increased cost, and poor function associated with autologous tendon harvest (currently considered the “gold standard” in clinical applications). An ideal scaffold for tendon and ligament reconstruction would be: naturally derived from either allogeneic or xenogeneic material amenable to host-cell mediated remodeling in vivo; devoid of cellular material to minimize inflammatory potential, disease transmission, and host immune response; cytocompatible; of optimal micro-architecture to promote efficient cell seeding, infiltration, and attachment of the recipient’s own cells prior to or after implantation; and distinguished by sufficient biomechanical integrity to withstand rehabilitation until complete remodeling has occurred. Such a scaffold should serve as template for cell attachment, promote rapid remodeling, possess increased strength, demonstrate improved healing, and permit early rehabilitation and return to function after implantation. In summary, an optimized scaffold would have the potential to vastly improve the treatment of tendon and ligament injuries, especially those associated with tumor, trauma, and congenital deficiencies where autograft or allograft tissue might not be available in sufficient quantity for reconstruction.