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. 2022 Nov 12;10:rbac091. doi: 10.1093/rb/rbac091

Table 5.

List of latest development of enthesis in tendons/ligaments

Tendons Ligaments Ref.
Compositions and structure
  • Connective tissue mainly including collagen and specialized cells tenocytes.

  • Collagen constitutes 65–80% of the dry mass of healthy tendons, including collagens types I, II, III, V, VIII, IX, X, XI, XII, XIV and XIX–XXI.

  • The basal membrane is composed of type IV collagen.

  • Dense connective tissue consists of fibroblasts, fibrocartilage and mainly collagen type I or elastin.

  • Directly or indirectly attached to the bone tissue, with the indirect attachment through Sharpey fibers.

[126, 127]
Mechanical properties
  • Different due to various elements including classification and methodological factors.

  • The strongest tendon in human body is the Achilles tendon, with the ultimate stress of 100 MPa, and the ultimate strain of 4–10%.

  • The attachment side of the soft and hard tissue is a weak point in deformation.

  • Different due to various elements including classification and methodological factors.

  • The attachment side of the soft and hard tissue is a weak point in deformation.

[126, 127]
Development of enthesis in tendons/ligaments
  • Constructing scaffolds with appropriate biomaterials, hierarchical organized architecture and specially designed structures in vitro.

  • Cultivation of cells and integration of factors on scaffolds.

  • Enhancing mechanical properties and testing engineering enthesis in vitro.

  • Performing in vivo implantation with histological evaluation but finding limitations in mechanical behavior.

  • Leveraging the advancements from biomaterials to replicate the native features of enthesis in vitro.

  • Finding cells leading to accelerated healing.

  • Improving mechanical properties including gradient in stiffness, shear loading and stress.

  • Injecting cells/biomaterials in animal models, but without scaffold grafting.

[59, 122, 128–132]