Background: Achilles tendon injuries are common, and present a challenge in the acute and
chronic setting. There is significant morbidity associated with the injury and the numerous management
strategies, as well as financial implications to the patient and the health service. To date, repair tissue
from all methods of management fail to achieve the same functional and biomechanical properties as
the native tendon.
Objective: The use of tissue engineering technology may reduce morbidity, improve the biomechanical
properties of repair tissue and reduce the financial burden. The goal is to produce completely integrated
tendon repair tissue that has the functional and mechanical properties of the native tendon. This review
evaluates the role of stem cells in tissue engineering for tendon reconstruction and the various sources
for harvesting stem cells.
Results: They can be obtained from the embryo, foetus or adult, and require the correct conditions for
proliferation and differentiation. There remain many ethical concerns with the use of embryo or foetus
harvested stem cells, thus the focus remains on adult sources, haematopoietic and non-haematopoietic.
The improving knowledge of the role of growth factors is addressed, as is their effect on animal models
for tendon repair. Growth factors include bone morphogenic proteins, transforming growth factor β,
insulin-like growth factor and platelet derived growth factor. The role of scaffolds in human and animal
models is reviewed, both naturally derived and synthetic scaffolds. Whilst numerous animal studies
have reported encouraging results, further work is required.
Conclusions: The ideal source of MSCs still has not been agreed upon, and little is known regarding
the signalling pathways involved in tenogenesis of MSCs. Whilst current studies have shown encouraging
results with regards to improved biomechanical and histological properties, further work is required
to ascertain the growth factors, biomaterials and source of stem cells required for tendon regeneration.