Electroactive fibrous scaffolds for tendon repair: From bioelectric microenvironment engineering to motion-driven and remotely activated stimulation.

Abstract

Tendon injuries rank among the most prevalent musculoskeletal disorders. Their clinical treatment remains challenging due to the inherently poor self-healing capacity and highly ordered hierarchical architecture of native tendon tissues. In recent years, electroactive fiber-based biomaterials have attracted growing attention in the field of tendon regeneration, attributed to their unique capability to mimic the fibrous microstructure of natural tissues while providing therapeutic electrical stimulation throughout tissue repair. In this review, recent advances in electroactive fibrous scaffolds for tendon repair are summarized, with particular focus on their biological functions and regenerative potential. First, the review introduces the bioelectrical microenvironment of native tendon tissues and explains its importance in tissue remodeling and healing. Then, the fundamental design strategies of biomimetic fibrous scaffolds are discussed, including fiber architecture, mechanical characteristics, and commonly used fabrication techniques. Different categories of electroactive material systems and electrically assisted repair approaches are then presented, including conductive scaffolds for wired electrical stimulation, piezoelectric scaffolds that generate electrical signals through physiological-motion-driven stimulation, and externally activated systems such as ultrasound (US) or magnetic fields (MF). Recent progress in intelligent electrotherapeutic platforms that integrate sensing, stimulation, and adaptive regulation into one integrated system is also outlined. Finally, current challenges associated with the clinical translation of electroactive fibrous scaffolds are analyzed, and prospective research directions in this field are proposed. STATEMENT OF SIGNIFICANCE: Electroactive fibrous scaffolds provide a unique opportunity to reconstruct both the anisotropic architecture and the bioelectrical microenvironment of injured tendon. However, fibrous scaffold design, electroactive materials, and electrical stimulation have largely been reviewed as separate topics. This review integrates these areas from a fiber-centered perspective and establishes a structure-property-stimulation-regeneration framework linking fiber alignment, hierarchical assembly, and functional-component distribution with mechanical behavior, electrical transduction, and tendon-regenerative responses. Conductive, motion-driven piezoelectric, remotely activated, and monitoring-enabled systems are critically compared within this framework. By defining how electroactive functions can be engineered through fibrous architecture, this review provides design principles for advancing passive tendon scaffolds toward programmable regenerative biointerfaces.