Advanced engineering strategies for biomaterial scaffolds application in tendon-bone interface regeneration

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Tendon-bone interface injuries, such as rotator cuff tears and anterior cruciate ligament ruptures, remain challenging due to the enthesis's complex structure and poor healing capacity. Conventional repair often fails to restore the fibrocartilaginous transition, causing mismatched integration and high retear rates. Biomaterial-based scaffolds provide biomechanical support and bioactive regulation, showing great promise for regeneration. Recent advances span natural polymers, synthetic polymers, bioceramics, and composites, with designs evolving from monophasic to multiphasic, gradient-based, and functionalized scaffolds. Emerging strategies emphasize immunomodulation, bio-signal delivery, and physical responsiveness, establishing a structure-signal-function paradigm to guide multi-tissue integration. However, translation faces major barriers, including inadequate animal models, manufacturing and scalability challenges, long-term safety concerns, and regulatory complexity, as well as the need to balance personalization with cost. Future directions point to intelligent biomaterials, AI-driven design, and integrated translational frameworks to bridge preclinical research and clinical application. Overall, advanced scaffold engineering offers transformative potential for functional tendon-bone regeneration, but successful translation will depend on close collaboration among biolog

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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