{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:02:15Z","timestamp":1790258535189,"version":"4.1.0"},"reference-count":66,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Mol. Sci.","IJMS"],"abstract":"<jats:p>Tendon and ligament injuries remain challenging to treat because healing may result in fibrosis, incomplete tendon\u2013bone integration, impaired biomechanical properties, and reinjury. This review critically synthesizes preclinical evidence on chitosan-based composite biomaterials for tendon\u2013ligament regeneration, focusing on their evolution from structural scaffolds toward multifunctional immunoregenerative platforms. Evidence across immune regulation, inflammatory signaling, angiogenesis, progenitor-cell activity, extracellular matrix remodeling, fibrocartilage formation, enthesis regeneration, tendon\u2013bone healing, and biomechanical recovery was evaluated, while distinguishing direct chitosan-related evidence from contextual evidence derived from broader biomaterial systems. Chitosan-based platforms may support multiple regenerative domains through structural guidance, bioadhesion, localized delivery of bioactive components, and formulation-dependent immunomodulatory activity. However, heterogeneity in chitosan physicochemical properties, composite formulations, experimental models, and outcome measures limits direct comparison and prevents definitive attribution of multicomponent effects to chitosan alone. We propose the Immunoregenerative Cascade Theory and Immunoregenerative Tendon\u2013Ligament Unit as complementary, hypothesis-generating frameworks for organizing temporal and spatial\u2013functional interactions during regeneration. These frameworks are not validated causal or predictive models. Future research should prioritize standardized biomaterial characterization, longitudinal molecular\u2013histological\u2013biomechanical assessment, emerging multi-omics approaches, clinically relevant large-animal validation, and mechanism-guided biomaterial design to establish whether immunoregulatory effects translate into durable structural and functional tendon\u2013ligament regeneration with long-term reproducible clinically meaningful recovery outcomes.<\/jats:p>","DOI":"10.3390\/ijms27198546","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:26:11Z","timestamp":1790256371000},"page":"8546","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immunoregenerative Microenvironment Modulation in Tendon\u2013Ligament Regeneration: Evolution of Chitosan-Based Composite Biomaterials"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1632-3052","authenticated-orcid":false,"given":"Muhammad Wibowo","family":"Ariyanto","sequence":"first","affiliation":[{"name":"Doctoral Program, Faculty of Medicine, Lambung Mangkurat University, Banjarbaru 70714, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zairin","family":"Noor","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, Lambung Mangkurat University, Banjarmasin 70233, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dwikora Novembri","family":"Utomo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, Airlangga University, Surabaya 60286, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oski","family":"Illiandri","sequence":"additional","affiliation":[{"name":"Doctoral Program, Faculty of Medicine, Lambung Mangkurat University, Banjarbaru 70714, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/bmb\/ldz040","article-title":"The role of the immune system in tendon healing: A systematic review","volume":"133","author":"Chisari","year":"2020","journal-title":"Br. Med. Bull."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2078","DOI":"10.1016\/j.jse.2016.06.009","article-title":"Rotator cuff repair: A review of surgical techniques, animal models, and new technologies under development","volume":"25","author":"Chevrier","year":"2016","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"rbac062","DOI":"10.1093\/rb\/rbac062","article-title":"Functional biomaterials for tendon\/ligament repair and regeneration","volume":"9","author":"Tang","year":"2022","journal-title":"Regen. Biomater."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1002\/bdrc.21041","article-title":"Tendon and ligament regeneration and repair: Clinical relevance and developmental paradigm","volume":"99","author":"Yang","year":"2013","journal-title":"Birth Defects Res. Part C Embryo Today Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1080\/00914037.2023.2299797","article-title":"Advanced biomaterials for tendon repair: Development and application","volume":"73","author":"Shen","year":"2024","journal-title":"Int. J. Polym. Mater. Polym. Biomater."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1007\/s12178-022-09794-z","article-title":"Return to play after posterior cruciate ligament injuries","volume":"15","author":"Kew","year":"2022","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1177\/03635465241238461","article-title":"Rates of subjective failure after both isolated and combined posterior cruciate ligament reconstruction: A study from the norwegian knee ligament registry 2004\u20132021","volume":"52","author":"Moatshe","year":"2024","journal-title":"Am. J. Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1089\/ten.teb.2022.0178","article-title":"Biomaterials for tissue-engineered treatment of tendinopathy in animal models: A systematic review","volume":"29","author":"Li","year":"2023","journal-title":"Tissue Eng. Part B Rev."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Russo, V., El Khatib, M., Prencipe, G., Cerver\u00f3-Varona, A., Citeroni, M.R., Mauro, A., Berardinelli, P., Faydaver, M., Haidar-Montes, A.A., and Turriani, M. (2022). Scaffold-mediated immunoengineering as innovative strategy for tendon regeneration. Cells, 11.","DOI":"10.3390\/cells11020266"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wang, Y., Lu, X., Lu, J., Hernigou, P., and Jin, F. (2024). The role of macrophage polarization in tendon healing and therapeutic strategies: Insights from animal models. Front. Bioeng. Biotechnol., 12.","DOI":"10.3389\/fbioe.2024.1366398"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Gao, H., Wang, L., Jin, H., Lin, Z., Li, Z., Kang, Y., Lyu, Y., Dong, W., Liu, Y., and Shi, D. (2022). Regulating macrophages through immunomodulatory biomaterials is a promising strategy for promoting tendon-bone healing. J. Funct. Biomater., 13.","DOI":"10.3390\/jfb13040243"},{"key":"ref_12","first-page":"1","article-title":"Healing of tendon-related diseases: Insights from macrophage regulation","volume":"12","author":"Chen","year":"2025","journal-title":"Mil. Med. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1089\/ten.teb.2023.0313","article-title":"Antiadhesion biomaterials in tendon repair: Application status and future prospect","volume":"31","author":"Zhang","year":"2025","journal-title":"Tissue Eng. Part B Rev."},{"key":"ref_14","first-page":"71","article-title":"Immunoregulative coating for scarless healing in anterior cruciate ligament reconstruction","volume":"45","author":"Wang","year":"2025","journal-title":"Bioact. Mater."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.jor.2025.05.022","article-title":"Advanced bioactive materials and strategies for tendon repair and function restoration","volume":"55","author":"Wang","year":"2025","journal-title":"J. Orthop. Transl."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2400968","DOI":"10.1002\/adhm.202400968","article-title":"A mesoporous silica-loaded multi-functional hydrogel enhanced tendon healing via immunomodulatory and pro-regenerative effects","volume":"13","author":"Wan","year":"2024","journal-title":"Adv. Healthc. Mater."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102903","DOI":"10.1016\/j.mtbio.2026.102903","article-title":"VEGF-sustained regulation and hydrogel-activated graded porous titanium scaffold for functional regeneration of the tendon-bone interface","volume":"37","author":"Lin","year":"2026","journal-title":"Mater. Today Bio"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"102964","DOI":"10.1016\/j.mtbio.2026.102964","article-title":"A sequential defense-nourishment strategy enabled by thermosensitive core-shell microneedles for synergistic tendon repair","volume":"37","author":"Fu","year":"2026","journal-title":"Mater. Today Bio"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.actbio.2019.04.035","article-title":"3D chitosan scaffolds impair NLRP3 inflammasome response in macrophages","volume":"91","author":"Vasconcelos","year":"2019","journal-title":"Acta Biomater."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"9952","DOI":"10.1016\/j.biomaterials.2013.09.012","article-title":"Macrophage polarization following chitosan implantation","volume":"34","author":"Vasconcelos","year":"2013","journal-title":"Biomaterials"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1039\/D4RA08406C","article-title":"Chitosan immunomodulation: Insights into mechanisms of action on immune cells and signaling pathways","volume":"15","author":"Ghattas","year":"2025","journal-title":"RSC Adv."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kim, Y., Zharkinbekov, Z., Raziyeva, K., Tabyldiyeva, L., Berikova, K., Zhumagul, D., Temirkhanova, K., and Saparov, A. (2023). Chitosan-based biomaterials for tissue regeneration. Pharmaceutics, 15.","DOI":"10.3390\/pharmaceutics15030807"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"691","DOI":"10.2174\/1574888X13666180809093343","article-title":"Preclinical studies on biomaterial scaffold use in knee ligament regeneration: A systematic review","volume":"13","author":"Archer","year":"2018","journal-title":"Curr. Stem Cell Res. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1243\/09544119JEIM203","article-title":"Chitosan-based hyaluronan hybrid polymer fibre scaffold for ligament and tendon tissue engineering","volume":"221","author":"Majima","year":"2007","journal-title":"Proc. Inst. Mech. Eng. Part H. J. Eng. Med."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Saatcioglu, E., Ulag, S., Sahin, A., Yilmaz, B.K., Ekren, N., Inan, A.T., Palaci, Y., Ustundag, C.B., and Gunduz, O. (2021). Design and fabrication of electrospun polycaprolactone\/chitosan scaffolds for ligament regeneration. Eur. Polym. J., 148.","DOI":"10.1016\/j.eurpolymj.2021.110357"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1002\/term.2985","article-title":"Possibilities and limitations of electrospun chitosan-coated polycaprolactone grafts for rotator cuff tear repair","volume":"14","author":"Willbold","year":"2019","journal-title":"J. Tissue Eng. Regen. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"27013","DOI":"10.1039\/C9RA03972D","article-title":"Biocompatible chitosan\u2013collagen\u2013hydroxyapatite nanofibers coated with platelet-rich plasma for regenerative engineering of the rotator cuff of the shoulder","volume":"9","author":"Tang","year":"2019","journal-title":"RSC Adv."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"4388","DOI":"10.1039\/C9BM00413K","article-title":"Bioactive LbL-assembled multilayer nanofilms upregulate tenogenesis and angiogenesis enabling robust healing of degenerative rotator cuff tendons in vivo","volume":"7","author":"Han","year":"2019","journal-title":"Biomater. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chevrier, A., Hurtig, M.B., and Lavertu, M. (2021). Chitosan\u2013platelet-rich plasma implants improve rotator cuff repair in a large animal model: Pivotal study. Pharmaceutics, 13.","DOI":"10.3390\/pharmaceutics13111955"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Teng, C., Fang, Y., Zhu, H., Huang, L., Jin, Y., and Ye, Z. (2021). A dual-factor releasing hydrogel for rotator cuff injury repair. Front. Mater., 8.","DOI":"10.3389\/fmats.2021.754973"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1177\/03635465211073148","article-title":"Evaluation of the effects of transforming growth factor\u2013beta 3 (TGF-\u03b23) Loaded nanoparticles on healing in a rat achilles tendon injury model","volume":"50","author":"Cetik","year":"2022","journal-title":"Am. J. Sports Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Szulc, M., and Lewandowska, K. (2022). Biomaterials based on chitosan and its derivatives and their potential in tissue engineering and other biomedical applications\u2014A review. Molecules, 28.","DOI":"10.3390\/molecules28010247"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.biomaterials.2018.08.054","article-title":"Immunomodulatory properties of chitosan polymers","volume":"184","author":"Moran","year":"2018","journal-title":"Biomaterials"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"119100","DOI":"10.1016\/j.carbpol.2022.119100","article-title":"Chitosan based bioadhesives for biomedical applications: A review","volume":"282","author":"Hamedi","year":"2022","journal-title":"Carbohydr. Polym."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"134172","DOI":"10.1016\/j.ijbiomac.2024.134172","article-title":"Chitosan as a tool for tissue engineering and rehabilitation: Recent developments and future perspectives\u2014A review","volume":"278","author":"Haider","year":"2024","journal-title":"Int. J. Biol. Macromol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"10446","DOI":"10.1039\/D4TB01362J","article-title":"Tissue adhesives based on chitosan for biomedical applications","volume":"12","author":"Youn","year":"2024","journal-title":"J. Mater. Chem. B"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.biomaterials.2014.10.035","article-title":"Modulation of the inflammatory response to chitosan through M2 macrophage polarization using pro-resolution mediators","volume":"37","author":"Vasconcelos","year":"2015","journal-title":"Biomaterials"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Huang, Y.-M., Lin, Y.-C., Chen, C.-Y., Hsieh, Y.-Y., Liaw, C.-K., Huang, S.-W., Tsuang, Y.-H., Chen, C.-H., and Lin, F.-H. (2020). Thermosensitive chitosan\u2013gelatin\u2013glycerol phosphate hydrogels as collagenase carrier for tendon\u2013bone healing in a rabbit model. Polymers, 12.","DOI":"10.3390\/polym12020436"},{"key":"ref_39","first-page":"91","article-title":"Study on injectable chitosan hydrogel with tendon-derived stem cells for enhancing rotator cuff tendon-to-bone healing","volume":"38","author":"Wen","year":"2024","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi"},{"key":"ref_40","first-page":"1","article-title":"Therapeutic effects of chitosan\/\u03b2-glycerophosphate\/collagen hydrogel combined with MSCs on chronic achilles tendon injury via the Akt\/GSK-3\u03b2 pathway","volume":"20","author":"Liu","year":"2025","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e2001305","DOI":"10.1002\/adhm.202001305","article-title":"Fibrous systems as potential solutions for tendon and ligament repair, healing, and regeneration","volume":"10","author":"Rinoldi","year":"2021","journal-title":"Adv. Healthc. Mater."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e2102344","DOI":"10.1002\/adhm.202102344","article-title":"Mechanically competent chitosan-based bioadhesive for tendon-to-bone repair","volume":"11","author":"Fang","year":"2022","journal-title":"Adv. Healthc. Mater."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"4823","DOI":"10.1021\/acsbiomaterials.4c00882","article-title":"Injectable hydrogel of chitosan-octyl itaconate conjugate modulates inflammatory response","volume":"10","author":"Zhou","year":"2024","journal-title":"ACS Biomater. Sci. Eng."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"149788","DOI":"10.1016\/j.ijbiomac.2025.149788","article-title":"Dual dynamic cross-linked self-healing chitosan-based hydrogels for microenvironmental reconstruction maintaining mitochondrial homeostasis to ameliorate tendinopathy progression","volume":"338","author":"Xu","year":"2025","journal-title":"Int. J. Biol. Macromol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1007\/s12640-021-00419-w","article-title":"Protective effect of chitosan oligosaccharide against hydrogen peroxide-mediated oxidative damage and cell apoptosis via activating Nrf2\/ARE signaling pathway","volume":"39","author":"Zhang","year":"2021","journal-title":"Neurotox. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.actbio.2026.03.004","article-title":"Functionalized biomimetic smart suture with composite coating combined with transcutaneous electrical stimulation for tendon\u2014Skin repair","volume":"214","author":"Jiang","year":"2026","journal-title":"Acta Biomater."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Abdollahi, A., Malek-Khatabi, A., Razavi, M.S., Sheikhi, M., Abbaspour, K., Rezagholi, Z., Atashi, A., Rahimzadegan, M., Sadeghi, M., and Javar, H.A. (2023). The recent advancement in the chitosan-based thermosensitive hydrogel for tissue regeneration. J. Drug Deliv. Sci. Technol., 86.","DOI":"10.1016\/j.jddst.2023.104627"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.reth.2023.09.007","article-title":"Emerging advances in hydrogel-based therapeutic strategies for tissue regeneration","volume":"24","author":"Li","year":"2023","journal-title":"Regen. Ther."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Zhang, R.-S., Zheng, Z.-Y., Zhu, G.-Q., Luo, C.-R., Yuan, J.-M., Ye, Y.-L., Zhuang, Z.-Q., Liu, Z.-Z., Li, Q.-C., and Huang, X.-Z. (2025). PRP-loaded hydrogel for rotator cuff repair by promoting osteogenic differentiation and tendon regeneration. Front. Bioeng. Biotechnol., 13.","DOI":"10.3389\/fbioe.2025.1655809"},{"key":"ref_50","first-page":"792","article-title":"Freeze-dried chitosan-platelet-rich plasma implants improve supraspinatus tendon attachment in a transosseous rotator cuff repair model in the rabbit","volume":"33","author":"Chevrier","year":"2018","journal-title":"J. Biomater. Appl."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"6777","DOI":"10.1021\/acsbiomaterials.5c01414","article-title":"Title Freeze-Dried Chitosan-thrombin-platelet-rich plasma implants improve supraspinatus tendon regeneration in a rabbit rotator cuff repair model","volume":"11","author":"Milano","year":"2025","journal-title":"ACS Biomater. Sci. Eng."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Najeb, M., Samy, A., Rizk, A., EL-Henawey, M., and Karrouf, G. (2026). Chitosan-augmented advanced platelet-rich fibrin improves the regeneration of superficial digital flexor tendon gap tenorrhaphy in donkeys (Equus asinus). Res. Sq.","DOI":"10.21203\/rs.3.rs-9390812\/v1"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"4633","DOI":"10.12659\/MSM.906747","article-title":"Effect of tendon stem cells in chitosan\/\u0392-glycerophosphate\/Collagen hydrogel on achilles tendon healing in a rat model\/\u03b2-glycerophosphate\/Effect of tendon stem cells in chitosan\/\u0392-glycerophosphate\/collagen hydrogel on achilles tendon healing in a rat model","volume":"23","author":"Yang","year":"2017","journal-title":"Med. Sci. Monit."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12951-024-03022-1","article-title":"Integrating electrospun aligned fiber scaffolds with bovine serum albumin-basic fibroblast growth factor nanoparticles to promote tendon regeneration","volume":"22","author":"Li","year":"2024","journal-title":"J. Nanobiotechnology"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"123149","DOI":"10.1016\/j.carbpol.2024.123149","article-title":"Biocompatible and stretchable chitosan piezoelectric gel with antibacterial capability and motion monitoring function for Achilles tendon rupture treatment","volume":"352","author":"Xiong","year":"2024","journal-title":"Carbohydr. Polym."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"125090","DOI":"10.1016\/j.carbpol.2026.125090","article-title":"Chitosan and \u03b3-polyglutamic acid interfacial polyelectrolyte complexation fibers for tendon biomimicry and regeneration","volume":"380","author":"Chen","year":"2026","journal-title":"Carbohydr. Polym."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1002\/jor.25678","article-title":"Preclinical tendon and ligament models: Beyond the 3Rs (replacement, reduction, and refinement) to 5W1H (why, who, what, where, when, how)","volume":"41","author":"Little","year":"2023","journal-title":"J. Orthop. Res."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Reifenrath, J., Wellmann, M., Kempfert, M., Angrisani, N., Welke, B., Gniesmer, S., Kampmann, A., Menzel, H., and Willbold, E. (2020). TGF\u2013\u03b23 loaded electrospun polycaprolacton fibre scaffolds for rotator cuff tear repair: An in vivo study in rats. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21031046"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"256","DOI":"10.2174\/1568026618666180410151518","article-title":"Current methods applied to biomaterials\u2014Characterization approaches, safety assessment and biological international standards","volume":"18","author":"Oliveira","year":"2018","journal-title":"Curr. Top. Med. Chem."},{"key":"ref_60","first-page":"337","article-title":"Translation of biomaterials from bench to clinic","volume":"18","author":"Zhang","year":"2022","journal-title":"Bioact. Mater."},{"key":"ref_61","first-page":"1","article-title":"Current hydrogel advances in physicochemical and biological response-driven biomedical application diversity","volume":"6","author":"Cao","year":"2021","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.knee.2025.04.018","article-title":"The role of chitosan in tissue healing after primary repair of quadriceps tendon ruptures: Experimental animal model","volume":"55","author":"Bayrak","year":"2025","journal-title":"Knee"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"9159","DOI":"10.2147\/IJN.S214359","article-title":"A LbL-assembled bioactive coating modified nanofibrous membrane for rapid tendon-bone healing in ACL reconstruction","volume":"14","author":"Han","year":"2019","journal-title":"Int. J. Nanomed."},{"key":"ref_64","first-page":"3737","article-title":"Freeze-dried chitosan-platelet-rich plasma implants for rotator cuff tear repair: Pilot ovine studies","volume":"4","author":"Chevrier","year":"2017","journal-title":"ACS Biomater. Sci. Eng."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Patel, S., Pan, J., Nguyen, A.P., Howard, N., and Thankam, F.G. (2026). Collagen-enriched immunomodulatory hydrogel for tendon regeneration. Gels, 12.","DOI":"10.3390\/gels12040317"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1039\/C6TB02671K","article-title":"Surface functionalized electrospun fibrous poly(3-hydroxybutyrate) membranes and sleeves: A novel approach for fixation in anterior cruciate ligament reconstruction","volume":"5","author":"Chen","year":"2016","journal-title":"J. Mater. Chem. B"}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/19\/8546\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:27:04Z","timestamp":1790256424000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/19\/8546"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":66,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["ijms27198546"],"URL":"https:\/\/doi.org\/10.3390\/ijms27198546","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]}}}