IBMS BoneKEy | Perspective

The role of mechanobiology in the attachment of tendon to bone

Stavros Thomopoulos

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DOI:10.1138/20110515

Abstract

The attachment of dissimilar materials is a major engineering challenge. Stress concentrations would arise at the interface of a compliant tendon and a stiff bone unless the interface was tuned to this mechanical mismatch. The functionally graded tissue that develops postnatally between tendon and bone provides a robust attachment that alleviates potential stress concentrations. This unique transitional tissue is not recreated during healing, so surgical reattachment of these two tissues often fails. “Mechanobiology”, the response of cells to changes in their mechanical environment, plays an important role in the development and homeostasis of musculoskeletal tissues. This Perspective reviews work examining structure-function relationships at the tendon-to-bone insertion and the role of mechanobiology in the development and healing of the tendon-to-bone insertion site. Results indicate that the tendon-to-bone insertion is a functionally graded material with regard to its extracellular matrix composition, its structural organization, its mineral content, and its mechanical properties. Animal models examining the development of the insertion indicate that mechanical loading is necessary for the maturation of the insertion into a functionally graded material. The role of loading tendon-to-bone during healing is more complex; low levels of load are beneficial and high levels of load are detrimental to healing. A better understanding of mechanobiology at the insertion may lead to rehabilitation and tissue engineering strategies for enhancing tendon-to-bone healing.

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