Biomedical Engineering Reference
In-Depth Information
Fig. 11.10 Precise control of loading is necessary for optimal tendon-to-bone healing after
surgical repair
11.6 Conclusions
The tendon-to-bone insertion is an example of a biological solution to the fundamental
problem of attaching two dissimilar materials. The enthesis possesses gradients in
structure and composition that help limit stress concentrations at the tendon-bone
interface. The development of the functional gradient requires muscle loading. The
healing insertion is also sensitive to its mechanical environment. However, a fine
balance must be reached between too much load (which can lead to damage) and too
little load (which can lead to a catabolic environment) to maximize tendon-to-bone
healing. Approaches for improving tendon-to-bone healing must focus on recreation
of a functionally graded transition between tendon and bone, either through manipu-
lation of the loading environment or though an engineered construct.
Acknowledgments This work was supported in part by the National Institutes of Health
(AR055580 and AR057836) and the National Science Foundation (CAREER 844607).
References
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Academy of Orthopaedic Surgeons, Rosemont, IL, pp 319-370
2. Woo SLAK, Frank CB, Livesay GA, Ma CB, Zeminski JA, Wayne JS, Myers BS (2000)
Anatomy, biology, and biomechanics of tendon and ligament. In: Buckwalter JA, Einhorn T,
Simon SR (eds) Orthopaedic basic science, 2nd edn. American Academy of Orthopaedic
Surgeons, Rosemont, IL, pp 581-616
3. Harryman DT II, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA III (1991)
Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone
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