Silk biomaterials for tendon and tendon-to-bone enthesis tissue engineering

Tendons and tendon-to-bone entheses are frequent injury sites among athletes, accounting for up to 50% of all sports-related injuries. Additionally, about 2%–5% of the general population is affected by tendinopathies up to some degree due to overuse, sport-related injuries, and/or degeneration. This situation is likely to worsen in the coming years due to the increasing popularity of sports practice among the middle-aged and elderly population. Unfortunately, the success rate of clinical intervention to treat tendinopathies is far from desirable, with surgical repair failure rates ranging from 20% to 90% in many cases. In this chapter, we review the perspective of tissue engineering to tackle the challenge that represents the successful treatment of injured tendon/enthesis. Furthermore, we look into the potential use of silk biomaterials in tendon and enthesis tissue engineering.