Advanced robotics to address the translational gap in tendon engineering

Advanced robotics to address the translational gap in tendon engineering

A review paper by scholars at Oxford university Discuss the potential benefits of using musculoskeletal robots and soft robotic systems as bioreactor platforms in the production of clinically useful tendon structures.

New review paper published on 15 September 2022 in the Journal Cyborg and Bionic Systems, summarizes current trends in tendon tissue engineering and discusses how conventional bioreactors are unable to provide physiologically relevant mechanical stimulation given that they are largely dependent on uniaxial tensile phases. The paper then highlights musculoskeletal robots and soft robotic systems as platforms to provide physiologically relevant mechanical stimulation that can overcome this translation gap.

Tendon and soft tissue injuries are a growing social and economic problem, with the tendon repair market in the United States estimated at US$1.5 billion. Tendon repair surgeries have a high rate of revision, with over 40% of rotator cuff repairs failing after surgery. Producing engineered tendon grafts for clinical use is a potential solution to this challenge. Conventional tendon bioreactors primarily provide uniaxial tensile stimulation. The lack of systems that recapitulate tendon loading in vivo is a major translation gap.

“The human body supplies tendons with 3D mechanical stress in the form of tension, compression, torsion and shear. Current research indicates that healthy native tendon tissue requires multiple types and directions of stress,” explained author Ian Sander, an Oxford researcher with Soft Tissue Engineering Research Group.

Musculoskeletal robotics were initially designed for applications such as crash test dummies, prosthetics, and sports augmentations. They try to imitate human anatomy by having similar body proportions, skeletal structure, muscle arrangement, and joint structure. Musculoskeletal hominids like Roboy and Kenshiro use tendon-driven systems with muscle actuators that mimic human neuromuscular tissue. Myorobotic units consist of a brushless DC motor that generates tension like a human muscle, accessory cables that act as a tendon unit, and a motorized dashboard with a spring encoder, which acts as a nervous system by sensing variables including tension, pressure, muscle length, and temperature. The proposed advantages of musculoskeletal humans include the ability to provide multiaxial loading, the potential for loading into account for human movement patterns, and the provision of loading volumes similar to forces in vivo. One recent study demonstrated the feasibility of culturing human tissue on a musculoskeletal robot for tendon engineering.

Biohybrid Soft Robotics is focused on developing biomimetic-compatible robotic systems that allow flexible and adaptive interactions with unpredictable environments. These automated systems are operated by a number of methods, including temperature, pneumatic and hydraulic pressure, and light. They are made of soft materials including hydrogels, rubber, and even human skeletal muscle tissue. These systems are already used to provide mechanical stimulation to smooth muscle tissue and have been implemented in vivo in a porcine model. These systems are attractive for tendon tissue engineering given that: 1) their flexible and compliant properties allow them to wrap around anatomical structures, mimicking native tendon formation 2) they are able to provide multi-axis operation and 3) a number of techniques used in soft robotics intertwine with engineering practices. Existing tendon tissues, and looking to the future, the team envisions advanced robotic systems as platforms that provide a physiologically appropriate mechanical stimulus for tendon grafting prior to clinical use. There are a number of challenges to consider when implementing advanced robotic systems. First, it will be important for future experiments to compare the technologies proposed in this review with conventional bioreactors. With the development of systems capable of providing multi-axis loading, it will be important to find ways to measure stress in a 3D image. Finally, advanced robotic systems will need to be affordable and widely accessible.

“A growing number of research groups are showing that it is possible to use advanced robotics in combination with living cells and tissues in tissue engineering and bioactivation applications. We are now at an exciting stage where we can explore the various possibilities to incorporate these technologies into tendon tissue engineering and examine whether they can really help with Improving the quality of engineered tendon grafts,” said Pierre Alexis Mathuy, senior author of the review article. In the long term, these technologies have the potential to improve the quality of life for individuals, by decreasing pain and the risk of tendon repair failure, healthcare systems, by reducing the number of revision surgeries, and for the economy, by improving and decreasing workplace productivity. health care costs.

The paper’s authors include Ian Sander, Nicole Dvorak, Julie Stebbins, Andrew J. Carr, and Pierre Alexis Mathuy.

This work was completed with financial support from the UK Engineering and Physical Sciences Research Council (project number: 17 P/S003509/1), and the Rhodes Fund.

The research paper, “Advanced Robotics to Address the Translational Gap in Tendon Engineering,” was published in the journal Cyborg and Bionic Systems on September 15, 2022, in the DOI:

Reference: Iain L. Sander1,2*, Nicole Dvorak1, Julie A. Stebbins1,2, Andrew J. Carr1, Pierre-Alexis Mouthuy1,3

Original paper title: Advanced robotics to address the transitional gap in tendon architecture

Magazine: Cyborg and Bionic Systems



  1. Botnar Research Centre, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
  2. 2 Oxford Gait Lab, Nuffield Orthopedic Centre, Tibbett Centre, Windmill Road, Oxford, OX3 7HE, 11 UK 12
  3. Orchid: 0000-0003-1192-6362

A brief introduction to the authors

Ian Sander:

Ian Sander is a graduate student in the Mouthuy Soft Tissue Research Group at the University of Oxford, where he completed his MSc in Musculoskeletal Sciences as a researcher from Rhodes University. He is currently completing his medical training at the University of Alberta in Canada. His research interests include clinical gait analysis, regenerative medicine, tendon injury, and tendon tissue engineering.

Nicole Dvorak:

Nicole Dvorak is a graduate student in the Mouthuy Soft Tissue Research Group at the University of Oxford and is currently completing a PhD in Musculoskeletal Sciences funded through the Oxford Center for Biomedical Research of the National Institute of Human Rights. You have previously completed a master’s degree. in Medical and Pharmaceutical Biotechnology at IMC FH Krems, Austria. Her research interests include tissue engineering and regenerative medicine.

Julie Stebbins:

Dr Julie Stebbins is a clinical scientist and director of the Oxford Gait Laboratory. She has published extensively in Clinical Gait Analysis, helped develop the Oxford Foot Model for Gait Analysis, and serves as Deputy Editor of Gait and Posture. Julie has been sought after internationally for her clinical gait analysis expertise and helped set up the first gait laboratory in Ethiopia.

Andrew Carr:

Professor Carr is the former Head of the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford. He is an orthopedic surgeon who helped develop Oxford’s partial knee replacement, which has been implanted in more than two million patients globally. He has authored more than 450 papers, including more than 25 presented in The Lancet and BMJ.

Pierre Alexis Mathuy

Professor Pierre-Alexis Mathuy is Associate Professor in the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford, where he leads the Oral Soft Tissue Research Group. He leads the multidisciplinary Human Bioreactor project, which aims to grow human tendons on human musculoskeletal robots, and has secured more than £1.2 million in funding for this project. He is an acknowledged researcher in the fields of biomaterials, tissue engineering and robotics.

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