Tendon/ligament injury is one of the most common impairments in sports medicine. The traditional treatments of damaged tissue repair are unsatisfactory, especially for athletes, due to lack of donor and immune rejection. The strategy of tissue engineering may break through these limitations, and bring new hopes to tendon/ligament repair, even regeneration. Silk is a kind of natural biomaterials, which has good biocompatibility, wide range of mechanical properties and tunable physical structures; so it could be applied as tendon/ligament tissue engineering scaffolds. The silk-based scaffold has robust mechanical properties; combined with other biological ingredients, it could increase the surface area, promote more cell adhesion and improve the biocompatibility. The potential clinical application of silk-based scaffold has been confirmed by in vivo studies on tendon/ligament repairing, such as anterior cruciate ligament, medial collateral ligament, achilles tendon and rotator cuff. To develop novel biomechanically stable and host integrated tissue engineered tendon/ligament needs more further micro and macro studies, combined with product development and clinical application, which will give new hope to patients with tendon/ligament injury.
肌腱和韧带损伤是临床常见运动系统损伤之一。传统治疗手段因供体来源有限、机体免疫排斥等局限,尚无法达到令人满意的临床疗效,尤其是对那些竞技运动员。目前的组织工程学手段能够突破传统治疗的局限,促进肌腱和韧带损伤的修复再生。蚕丝是一种天然的生物材料,具有生物相容性较好、力学强度跨度大和物理结构可调节等特性,可以作为肌腱和韧带的组织工程支架。以蚕丝支架为核心提供力学支持,复合胶原等其他生物成分能增加支架的三维空间,促进更多细胞黏附,并提升材料的生物相容性。体内研究逐步验证了蚕丝支架在发病率较高的肌腱和韧带(前交叉韧带、内侧副韧带、跟腱、肩袖韧带)修复中的临床应用潜能。生物力学良好,宿主自然整合的组织工程肌腱和韧带需要深入基础微观领域研究和延伸临床操作领域研究,促进产品走出实验室,开辟临床应用新航路,为肌腱和韧带损伤患者带来新的希望。本文就蚕丝相关组织工程支架的历史演变及其用于肌腱和韧带损伤修复的效果进行综述和展望。