Braided suture-reinforced fibrous yarn bundles as a scaffold for tendon tissue engineering in extensor digitorum tendon repair

In this study, we intend to develop an effective tendon tissue engineering scaffold that can provide mechanical stability and tendon regeneration ability. Using a novel electrospinning process, a biodegradable suture was continuously covered with aligned polycaprolactone fibers in core/sheath structure to produce a single yarn. The single yarn was braided together to fabricate a multi yarn (MY) scaffold, which can be surface modified with oxygen plasma and conjugated with heparin. The fibroblast growth factor 2 (FGF2) was bound to MY through bioaffinity between heparin and FGF2 to generate a functional scaffold (MY-FGF2) suitable for extensor dig-itorum tendon (EDT) repair. The physico-chemical properties of the scaffolds were characterized throughout the modification steps using microscopy, spectroscopy and mechanical testing. In vitro static culture using rabbit tendon-derived fibroblasts (rTFs) indicates combined effects of FGF2 and fiber alignment can enhance cell proliferation and extracellular matrix synthesis rates, as well as fasten tendon maturation. The cytoskeleton staining further endorses aligned morphology of fibers direct cell growth and collagen fiber deposition along the fiber axial direction, mimicking native tendon features. The dynamic culture in a bioreactor under uniaxial cyclic tensile loading authenticates 5 % mechanical stimulation can further increase cell proliferation and tenogenic differentiation rates compared to static culture. After mechanical stimulation for 7 days in vitro, the MY-FGF2/ rTFs construct was used for repair of EDT defects in rabbits. The retrieved MY-FGF2/rTFs sample 6-week post -implantation shows superior mechanical properties and tendon regeneration abilities over acellular MY-FGF2. Taken together, we demonstrate a combinatory approach with MY-FGF2 where chemical and physical cues provided by FGF2, fiber alignment and dynamic stimulation contribute to tendon regeneration with a specific focus on EDT repair.