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The human musculoskeletal system functions through the coordinated actions of various tissues, providing support and stability while allowing organized movement of muscles and bones. Ligaments connect bones to bones, and tendons connect muscles to bones, making connective tissue an essential component of our body. The transition from muscle to bone, called the tendon-bone interface (TBI), is a highly specialized site that can effectively transfer tensile loads from soft tissue to hard tissue. These interfaces exhibit gradient changes in structure, composition, and mechanical properties, which effectively transfer stress between tendons and bones. Tendon or ligament insertion tears are common clinical problems in orthopedic practice. Rotator cuff injuries are one of the most common sports injuries, which usually cause shoulder pain, weakness, and limited range of motion, ultimately placing a heavy economic burden on families and society. Rotator cuff tears limit the movement of the shoulder joint and seriously affect the patient's daily life. Rotator cuff tears usually require surgical repair. Although some patients have significant improvement in shoulder function after surgery, the re-fracture rate is still high, ranging from 15-94%. The high re-rupture rate can be attributed to the fact that the injury site is usually located at the tendon-bone interface, the complex structure and composition make repair difficult, and scarring leads to tissue fragility. Faced with the current situation, rotator cuff surgery remains a challenge and better solutions need to be developed to avoid postoperative recurrence
The main point of this paper
Transition structure of tendon-bone interface:
There is a transition of four layers of structure and composition between tendon and bone: tendon, non-mineralized fibrocartilage, mineralized fibrocartilage and bone.
This transition zone helps transfer force from tendon to bone and reduces stress concentration.
Challenges in the healing process:
After injury of the bone-tendon interface, the unique transition tissue fails to rebuild, resulting in fibrocartilage regeneration, bone loss and immune dysregulation.
The imbalance between pro-inflammatory and anti-inflammatory macrophages affects the healing process.
Inflammatory response and healing:
During the tendon-bone healing process, it is necessary to improve the abnormal inflammatory response, promote cartilage regeneration, reduce bone loss and promote osteogenic differentiation.
Importance of tissue engineering:
Tissue engineering can simulate natural tissue, provide an extracellular matrix (ECM) environment, and play an important role in regulating stem cell behavior and fate.
Application of electrospinning technology:
Electrospinning technology can produce polymer fibers with a diameter of 50-1000 nanometers, similar to natural collagen fibers in tendons.
Electrospun nanofibrous scaffolds promoted cell adhesion, growth, proliferation and even differentiation and showed good regenerative effects.
Importance:
The tendon-bone interface (TBI) is a critical site in the musculoskeletal system responsible for transmitting muscle force to bone.
TBI injuries are common and difficult to repair, resulting in a high re-rupture rate.
Challenges:
The TBI is a complex structure consisting of four layers: tendon, non-mineralized fibrocartilage, mineralized fibrocartilage, and bone.
The unique transitional tissue between tendon and bone is difficult to reconstruct during the healing process.
Role of tissue engineering:
Tissue engineering mimics natural tissue and provides an extracellular matrix (ECM) environment that has a significant impact on stem cell behavior and fate.
Application of electrospinning technology:
Electrospinning technology can produce polymer fibers with a diameter of 50-1000 nanometers, which mimic the natural collagen fibers in tendons.
The nanofiber scaffolds prepared by this technology promote cell adhesion, growth, proliferation, and differentiation, showing good regenerative effects.
Research progress:
The review emphasizes the potential of electrospinning technology in the manufacture of scaffolds and its role in promoting the development of functional and integrated tendon-bone interface tissues.
Electrospinning technology offers a new approach to address the challenges of tendon-bone interface regeneration, especially in mimicking the ECM of native tissue and promoting cellular behavior.
As part of this article, the authors summarize the application of electrospinning technology in tendon-bone interface tissue design. Various types of cells remain stable within the tendon-bone interface, which allows for efficient transmission of muscle force to the bone. The healing mechanism of the tendon-bone interface is complex but critical to patient prognosis, and current treatments are still insufficient in achieving complete reconstruction of the tendon-bone interface. The research progress on the biological and mechanical mechanisms of tendon-bone interface healing is reviewed, and the developmental characteristics and healing mechanisms of the injured interface are discussed, mainly involving molecular biology, physical factors stimulation, and mechanical stimulation. This article also discusses the strategies and materials for preparing bone-tendon interface tissue engineering scaffolds using electrospinning technology. Tissue engineering to achieve regeneration of muscle-tendon/ligament-bone interfaces provides an attractive strategy to provide functional transplants and improve clinical outcomes after injury. Nevertheless, due to its complex structure and the critical interdependence between structure, function, and mechanical properties, tissue engineering of attachment sites is a major challenge for biologists and engineers.
