Tendon injuries disrupt the transmission of forces from muscle to bone, leading to chronic pain, disability, and a large socioeconomic burden. Tendon injuries are prevalent; there are over 300,000 tendon repair procedures a year in the United States to address acute trauma or chronic tendinopathy. Successful restoration of function after tendon injury remains challenging clinically. Despite improvements in surgical and physical therapy techniques, the high complication rate of tendon repair procedures motivates the use of therapeutic interventions to augment healing. While many biological and tissue engineering approaches have attempted to promote scarless tendon healing, there is currently no standard clinical treatment to improve tendon healing. Moreover, the limited efficacy of systemic delivery of several promising therapeutic candidates highlights the need for tendon-specific drug delivery approaches to facilitate translation. This review article will synthesize the current state-of-the-art methods that have been used for tendon-targeted delivery through both systemic and local treatments, highlight emerging technologies used for tissue-specific drug delivery in other tissue systems, and outline future challenges and opportunities to enhance tendon healing through targeted drug delivery.
Impact statement
Tendon injuries heal in a scar-mediated manner, which lead to numerous complications. However, there is currently no pharmacological approach to augment the tendon healing process. This can be attributed to the lack of targeting modalities within the tendon to which drug carriers can be directed, as well as the lack of effective therapeutic molecules. In this review, we identify promising approaches that are currently used in other tissues, which can be leveraged to promote effective, tendon-targeted drug delivery and provide our perspective on the key considerations for tendon-targeted drug delivery, and the challenges and opportunities that exist in this space.
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