Tendon regeneration deserves better: focused review on <i>In vivo</i> models, artificial intelligence and 3D bioprinting approaches

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 regeneration has been one of the most challenging issues in orthopedics. Despite various surgical techniques and rehabilitation methods, tendon tears or ruptures cannot wholly regenerate and gain the load-bearing capacity the tendon tissue had before the injury. The enhancement of tendon regeneration mostly requires grafting or an artificial tendon-like tissue to replace the damaged tendon. Tendon tissue engineering offers promising regenerative effects with numerous techniques in the additive manufacturing context. 3D bioprinting is a widely used additive manufacturing method to produce tendon-like artificial tissues based on biocompatible substitutes. There are multiple techniques and bio-inks for fabricating innovative scaffolds for tendon applications. Nevertheless, there are still many drawbacks to overcome for the successful regeneration of injured tendon tissue. The most important target is to catch the highest similarity to the tissue requirements such as anisotropy, porosity, viscoelasticity, mechanical strength, and cell-compatible constructs. To achieve the best-designed artificial tendon-like structure, novel AI-based systems in the field of 3D bioprinting may unveil excellent final products to re-establish tendon integrity and functionality. AI-driven optimization can enhance bio-ink selection, scaffold architecture, and printing parameters, ensuring better

Evidence level

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

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