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Table 6 Performance of composites, blends and hybrid materials based on natural polymers for ligament/tendon TE

From: Biodegradable polymer nanocomposites for ligament/tendon tissue engineering

MaterialScaffoldApplicationIn vivo/in vitroMechanical responseBiological responseRefs.
Young’s modulus(MPa)Stiffness (N/mm)Max. strength (MPa)Max. load (N)
Silk-ColCol -sponge incorporated into a freeze-dried knitted silk mesh
(i) addition of: rhSDF-1 alpha
(ii) no rhSDF-1 alphaa
LigamentIn vivo, rabbit modelND7.02 ± 1.25 (at 16 weeks after surgery)NDFibroblasts distribution throughout the scaffold, at 4 weeks post-implantation
At 16 weeks postoperatively, host cells had invaded the core of the scaffold
[102]
49.49 ± 10.14 (at 16 weeks post surgery) ND~ 25 ± 12At 2 weeks post-reconstruction, spindle tendon-like cells and vascularization
At 12 weeks, ligament-ECM deposition
[101]
Ligament/tendonIn vitro (BMSCs); In vivo, rabbit modelND24.3 ± 2.9ND47.0 ± 7.4At 15–360 days after implantation, tissue ingrowth by fibroblasts between the fibers
At 4 weeks, denser ECM, larger number of cells, spindle-shaped morphology
Rarely vascularity; no evident inflammation
[54]
In vitro (human embryonic-stem cells MSCs)
In vivo, mouse model
(i) Dynamic mechanical stress
(ii) No mechanical stress
24.44 ± 10.03 (unseeded)NDIn vitro: MSCs adhesion, proliferation
(i) After 14 days, cells elongation, aligned along the direction of mechanical stress
In vivo: (i) Aligned cells and larger collagen fibers comparing to (ii) After 4 weeks post-surgery, tendon-related ECM, indicating tenocyte-lineage
[98]
TendonIn vitro (BMSCs, HDF), Achilles tendon fibroblasts (ATFs)
In vivo, rat modela
(i) 45.3 ± 10.4
(ii) 32.6 ± 3.9a
ND(i) 68.5 ± 18.0 (ii) 65.7 ± 10.3a(i), (ii) At 4 days post-surgery neo-tendons appeared with cord-like shapea
(i) Migratory BMSCs/HDF; vascularization; at 1 week post-surgery more fibroblasts and ECM; At 4 weeks, organized bundles of collagen fibers
[99]
CHI-HABraid with wetspun fibersLigament/TendonIn vitro (fibroblast rabbit PT)
(i) static
(ii) stretch
(iii) rotation
(iv) stretch+ rotation
NDCell adhesion and proliferation
(iv) Higher cell proliferation after 21 days of culture and ECM production after 14 days of culture, comparing to i-(iii)
(iii) Higher cell proliferation than (i) and (ii)
[117]
Silk coated with Col-HA(i) Knitted silk
(ii) Freeze-dried silk coated with Col-HA
LigamentIn vitro (Human ACL fibroblasts); In vivo, dog modelNDIn vitro: (ii) Higher cell attachment, proliferation and ECM synthesis than (i)
In vivo: (i), (ii) Synovitis; (ii) induced angiogenesis, new collagen formation and higher vascularity than (i)
[103]
  1. arhSDF-1 alpha(exogenous recombinant human SDF): cytokine that regulates stem cell homing