Challenges and opportunities of medicines for treating tendon inflammation and fibrosis: A comprehensive and mechanistic review

Abstract Background Tendinopathy refers to conditions characterized by collagen degeneration within tendon tissue, accompanied by the proliferation of capillaries and arteries, resulting in reduced mechanical function, pain, and swelling. While inflammation in tendinopathy can play a role in preventing infection, uncontrolled inflammation can hinder tissue regeneration and lead to fibrosis and impaired movement. Objectives The inability to regulate inflammation poses a significant limitation in tendinopathy treatment. Therefore, an ideal treatment strategy should involve modulation of the inflammatory process while promoting tissue regeneration. Methods The current review article was prepared by searching PubMed, Scopus, Web of Science, and Google Scholar databases. Several treatment approaches based on biomaterials have been developed. Results This review examines various treatment methods utilizing small molecules, biological compounds, herbal medicine‐inspired approaches, immunotherapy, gene therapy, cell‐based therapy, tissue engineering, nanotechnology, and phototherapy. Conclusion These treatments work through mechanisms of action involving signaling pathways such as transforming growth factor‐beta (TGF‐β), mitogen‐activated protein kinases (MAPKs), and nuclear factor kappa‐light‐chain‐enhancer of activated B cells (NF‐κB), all of which contribute to the repair of injured tendons.