title: Biologics for tendon repair.
abstract: Tendon injuries are common and present a clinical challenge to orthopedic surgery mainly because these injuries often respond poorly to treatment and require prolonged rehabilitation. Therapeutic options used to repair ruptured tendons have consisted of suture, autografts, allografts, and synthetic prostheses. To date, none of these alternatives has provided a successful long-term solution, and often the restored tendons do not recover their complete strength and functionality. Unfortunately, our understanding of tendon biology lags far behind that of other musculoskeletal tissues, thus impeding the development of new treatment options for tendon conditions. Hence, in this review, after introducing the clinical significance of tendon diseases and the present understanding of tendon biology, we describe and critically assess the current strategies for enhancing tendon repair by biological means. These consist mainly of applying growth factors, stem cells, natural biomaterials and genes, alone or in combination, to the site of tendon damage. A deeper understanding of how tendon tissue and cells operate, combined with practical applications of modern molecular and cellular tools could provide the long awaited breakthrough in designing effective tendon-specific therapeutics and overall improvement of tendon disease management.
authors.affiliation: Experimental Surgery and Regenerative Medicine, Department of Surgery, Ludwig Maximilians University, Nussbaumstr. 20, 80336 Munich, Germany. Electronic address: denitsa.docheva@med.uni-muenchen.de.
authors.forename: Denitsa
authors.initials: D
authors.lastname: Docheva
authors.affiliation: Department of Orthopedic Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
authors.forename: Sebastian A
authors.initials: SA
authors.lastname: Müller
authors.affiliation: Department of Orthopedic Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Majewski
authors.affiliation: Rehabilitation Medicine Research Center, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Evans
mesh_terms: D001672:Biocompatible Materials / Q000008:administration & dosage* / Q000494:pharmacology; D015316:Genetic Therapy / Q000379:methods*; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000008:administration & dosage* / Q000494:pharmacology; D012038:Regeneration / Q000187:drug effects / Q000502:physiology*; D033581:Stem Cell Transplantation / Q000379:methods*; D013710:Tendons / Q000187:drug effects / Q000502:physiology*
chemical_list: D001672:Biocompatible Materials; D036341:Intercellular Signaling Peptides and Proteins
keywords: Cell-based therapy; Embryonic stem cells; Gene therapy; Growth Factors; Mesenchymal stem cells; Natural biomaterials; Tendon; Tendon repair; Tendon-derived cells