Current Status of Tissue-engineered Scaffolds for Rotator Cuff Repair

Rotator cuff tears continue to be at significant risk for retear or for failure to heal after surgical repair despite the use of a variety of surgical techniques and augmentation devices. Therefore, there is a need for functionalized scaffold strategies to provide sustained mechanical augmentation during the critical first 12 weeks after repair, and to enhance the healing potential of the repaired tendon and tendon-bone interface. Tissue-engineered approaches that combine the use of scaffolds, cells, and bioactive molecules toward promising new solutions for rotator cuff repair are reviewed. The ideal scaffold should have adequate initial mechanical properties, be slowly degrading, or nondegradable, have nontoxic degradation products, enhance cell growth, infiltration and differentiation, promote regeneration of the tendon-bone interface, be biocompatible, and have excellent suture retention and handling properties. Scaffolds that closely match the inhomogeneity and nonlinearity of the native rotator cuff may significantly advance the field. Although substantial preclinical work remains to be done, continued progress in overcoming current tissue engineering challenges should allow for successful clinical translation.