2023, Vol. 27 ›› Issue (18): 2928-2934

Regeneration mechanism and problems of tissue engineering in rotator cuff tendon-bone healing

Wang Xu1, 2, Yang Tengyun2, 3, Xiong Bohan2, 3, Zhang Yaozhang2, 3, Lu Xiaojun2, 3, Long Dan2, 3, Zhao Daohong1, 2   

Abstract: BACKGROUND: In recent years, arthroscopic rotator cuff repair has become the “gold standard” of clinical treatment. However, the rate of postoperative retears after rotator cuff repair remains high, mainly because the original rotator cuff structure cannot be restored. Therefore, anatomical healing through surgery alone is not sufficient. With the development of tissue engineering, more and more scholars have found that it has great advantages for rotator cuff healing and can help stimulate the orderly regeneration of the tendon bone interface. As scholars continue to go deeper and deeper, various types of scaffolds, seed cells, and growth factors have emerged, which have great prospects. However, there are few related reviews at the domestic and international levels, which makes it inconvenient for clinicians and scholars in related fields to understand the recent status of research in general.  
OBJECTIVE: To provide a summary of recent research on scaffold materials, seed cells, and cytokines related to tissue engineering in the field of rotator cuff tendon bone healing, with the aim of shedding light on basic research and clinical progress in rotator cuff tendon bone healing.
METHODS: The search terms “rotator cuff injury, tissue engineering” were searched in English and Chinese by computer in PubMed and CNKI databases. The literature retrieved within 10 years was screened to exclude irrelevant, low quality or duplicate literature, and other relevant literature was included manually. Eventually, 69 papers were included for result analysis.  
RESULTS AND CONCLUSION: Tissue engineering has a great potential in the field of regeneration of tendon-bone union sites. (1) Current scaffold materials can be broadly classified into three types (natural material scaffold, synthetic material scaffold, and composite material scaffold), each with its own advantages. However, composite scaffolds seem to be more promising as they can better mimic the original gradient structure of the tendon-bone interface. (2) The pigmentation of various types of stem cells and biologic factors has also been shown to stimulate the repair potential of damaged areas. Moreover, the selection of stem cell types and the study of the intrinsic molecular signaling pathways of various biologic factors still need to be further investigated, so as to clarify the time point and level of intervention of specific biologic factors and achieve the purpose of precisely inducing the regeneration of the original four-layer structure.
Key words: rotator cuff injury, tendon-bone healing, tissue engineering, scaffold, stem cell, review