Highly bio-adapted hydrogels for tendon-bone interface regeneration: Natural healing inspiration, design strategies, and biomedical potential

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)

Against the dual backdrop of a global push to promote physical activity and the progressive degeneration of the musculoskeletal system due to aging, a significant imbalance has emerged between life expectancy and quality of life. Tendon-bone interface (TBI) injuries markedly impair physical function and overall well-being. The anatomical gradient structure of the TBI, along with the spatiotemporal complexity of its cellular composition and distribution, poses substantial challenges to postoperative healing. This review examines the vulnerability of the TBI under physiological conditions, the spatial gradient distribution of various functional cell types, and the concentration gradients of cytokines. We further introduce the reparative processes that occur following TBI injury and highlight key strategies for interface regeneration. In recent years, advances in tissue engineering have endowed hydrogels with unique biological properties and potential to mimic the gradient architecture of native TBI tissue, making them promising candidates for TBI repair and thereby improving clinical outcomes. We categorize current hydrogel-based strategies for enhancing TBI healing into four main types: improving hydrogel physicochemical properties, mimicking native anatomical structures, replicating dynamic gradients of cells and cytokines, and responding adaptively to the healing microenvironm

Evidence level

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

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