Caleb Wagner

Advances in silk-based tissue-engineered constructs offer promising opportunities to improve tendon and ligament repair by increasing graft availability and enhancing patient outcomes. The rising demand for tendon and ligament reconstruction highlights the need for biomaterials that address limitations of autografts and allografts, including donor-site morbidity, limited supply, and immune rejection risks. Silk-based scaffolds leverage their tunable biomechanical properties—such as Young’s modulus, ultimate tensile strength, and strain to failure—to closely mimic native tendon and ligament function. This review synthesizes current literature on silk-derived grafts, summarizing their mechanical performance, fabrication strategies, and translational potential. Emphasis is placed on spider silk, which demonstrates exceptional tensile strength, elasticity, and biocompatibility, making it a strong candidate for next-generation scaffolds. Remaining challenges include optimizing in vivo degradation rates, enhancing tendon-to-bone (enthesis) integration, developing tunable structural and biochemical features, improving manufacturability, and validating clinical efficacy through standardized testing and robust clinical trials. Additional limitations to the application of silk as a biomaterial scaffold include high production costs, challenges associated with controlled spinning and processing, and the current lack of scalable manufacturing methods. Continued innovation and rigorous preclinical and clinical evaluation will be critical to realizing silk’s potential in advancing tendon and ligament repair and improving long-term functional outcomes.

(1) Background: Osteoarthritis is a degenerative joint disease that is commonly diagnosed in the aging population. Interestingly, the lower extremity joints have a higher published incidence of osteoarthritis than the upper extremity joints. Although much is known about the disease process, it remains unclear why some joints are more affected than others. (2) Methods: A comprehensive literature review was conducted utilizing the search engines PubMed, Google Scholar, and Elsevier from 2014 to 2024, directing our search to osteoarthritis of various joints, with the focus being on glenohumeral osteoarthritis. (3) Results and Discussion: The literature review revealed a publication difference, which may be explained by the inconsistency in classification systems utilized in the diagnosis of shoulder osteoarthritis. For instance, there are six classification systems employed in the diagnosis of glenohumeral osteoarthritis, making the true incidence and, therefore, the prevalence unobtainable. Furthermore, susceptibility to osteoarthritis in various joints is complicated by factors such as joint anatomy, weight-bearing status, and prior injuries to the joint. (4) Conclusions: This review reveals the lack of understanding of shoulder osteoarthritis’s true incidence and prevalence while considering the anatomy and biomechanics of the glenohumeral joint. In addition, this is the first paper to suggest a single criterion for the diagnosis of glenohumeral osteoarthritis.