Beyond the enthesis: Evidence and translational challenges for coordinated multi-tissue repair in rotator cuff tears
- 1Day Surgery Center, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- 2Department of Sports Medicine, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- 3Department of Minimally Invasive Surgery, Spine Hospital, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
Abstract
Despite advances in surgical techniques, outcomes after rotator cuff repair remain limited by concurrent biological and mechanical deficits involving the proximal muscle, tendon, enthesis, and peri-fixation bone. Structural reattachment alone does not fully address redox dysregulation, context-dependent inflammatory signaling, disorganized matrix remodeling, bone loss, muscle atrophy, or fatty infiltration. This narrative review evaluates compartment-specific interventions and biomaterial strategies designed to address these interacting constraints. Evidence remains predominantly preclinical and is strongest for tendon–enthesis–bone augmentation through injectable and self-healing hydrogels, fibrous or gradient scaffolds, and responsive or sequential delivery systems. By contrast, proximal muscle preservation has largely been studied separately through pharmacological, physical, metabolic, progenitor-directed, and rehabilitation-based interventions. We define coordinated multi-tissue repair as a therapeutic and evaluation framework aligning anatomically appropriate interventions with structural, biological, mechanical, and functional outcomes. Here, integration denotes spatial or compositional organization within a tendon–enthesis–bone construct, whereas coordination aligns anatomically separate treatment domains through timing, rehabilitation, and shared outcomes. Coordination does not require a single construct spanning all affected compartments. We distinguish direct rotator cuff evidence from transferable findings in related musculoskeletal interfaces and from unvalidated design proposals. Representative platforms are compared in terms of intended roles, mechanical limitations, degradation requirements, manufacturing constraints, safety considerations, and validation needs. Future studies should use matched controls, longitudinal assessment, and compartment-resolved outcomes to determine whether spatial organization, sequential delivery, and anatomically separate muscle-directed treatment provide incremental benefit. Translation will require clinically relevant models and prospective, risk-stratified evaluation.
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BibTeX
@article{li2026beyond,
title = {{Beyond the enthesis: Evidence and translational challenges for coordinated multi-tissue repair in rotator cuff tears}},
author = {Dong Li and Haifan Wang and Shaolong Ma and Xiaobin Yang and Jinming Tian and Mingzhe Wu},
journal = {Journal of Tissue Engineering},
year = {2026},
month = sep,
doi = {10.1177/20417314261489937},
url = {https://doi.org/10.1177/20417314261489937},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Beyond the enthesis: Evidence and translational challenges for coordinated multi-tissue repair in rotator cuff tears
AU - Dong Li
AU - Haifan Wang
AU - Shaolong Ma
AU - Xiaobin Yang
AU - Jinming Tian
AU - Mingzhe Wu
PY - 2026
DA - 2026/09/20
JO - Journal of Tissue Engineering
DO - 10.1177/20417314261489937
UR - https://doi.org/10.1177/20417314261489937
AB - Despite advances in surgical techniques, outcomes after rotator cuff repair remain limited by concurrent biological and mechanical deficits involving the proximal muscle, tendon, enthesis, and peri-fixation bone. Structural reattachment alone does not fully address redox dysregulation, context-dependent inflammatory signaling, disorganized matrix remodeling, bone loss, muscle atrophy, or fatty infiltration. This narrative review evaluates compartment-specific interventions and biomaterial strategies designed to address these interacting constraints. Evidence remains predominantly preclinical and is strongest for tendon–enthesis–bone augmentation through injectable and self-healing hydrogels, fibrous or gradient scaffolds, and responsive or sequential delivery systems. By contrast, proximal muscle preservation has largely been studied separately through pharmacological, physical, metabolic, progenitor-directed, and rehabilitation-based interventions. We define coordinated multi-tissue repair as a therapeutic and evaluation framework aligning anatomically appropriate interventions with structural, biological, mechanical, and functional outcomes. Here, integration denotes spatial or compositional organization within a tendon–enthesis–bone construct, whereas coordination aligns anatomically separate treatment domains through timing, rehabilitation, and shared outcomes. Coordination does not require a single construct spanning all affected compartments. We distinguish direct rotator cuff evidence from transferable findings in related musculoskeletal interfaces and from unvalidated design proposals. Representative platforms are compared in terms of intended roles, mechanical limitations, degradation requirements, manufacturing constraints, safety considerations, and validation needs. Future studies should use matched controls, longitudinal assessment, and compartment-resolved outcomes to determine whether spatial organization, sequential delivery, and anatomically separate muscle-directed treatment provide incremental benefit. Translation will require clinically relevant models and prospective, risk-stratified evaluation.
SN - 2041-7314
ER -