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Biology and augmentation of tendon-bone insertion repair

Pauline Po-Yee Lui123*, Peng Zhang4, Kai-Ming Chan12 and Ling Qin14*

Author Affiliations

1 Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

2 The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

3 Program of Stem Cell and Regeneration, School of Biomedical Science, The Chinese University of Hong Kong, Hong Kong SAR, China

4 Translational Medicine Research and Development Center, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, The Chinese Academy of Science, Shenzhen, Guangdong Province, China

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Journal of Orthopaedic Surgery and Research 2010, 5:59  doi:10.1186/1749-799X-5-59

Published: 21 August 2010

Abstract

Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL) reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis") which connects tendon to bone. Tendon-to-bone healing taking place between inhomogenous tissues is a slow process compared to healing within homogenous tissue, such as tendon to tendon or bone to bone healing. Therefore special attention must be paid to augment tendon to bone insertion (TBI) healing. Apart from surgical fixation, biological and biophysical interventions have been studied aiming at regeneration of TBI healing complex, especially the regeneration of interpositioned fibrocartilage and new bone at the healing junction. This paper described the biology and the factors influencing TBI healing using patella-patellar tendon (PPT) healing and tendon graft to bone tunnel healing in ACL reconstruction as examples. Recent development in the improvement of TBI healing and directions for future studies were also reviewed and discussed.