Design Considerations, Formulation Approaches, and Strategic Advances of Hydrogel Platforms for Tendinopathy Management

Tendinopathy is a musculoskeletal disorder characterized by severe pain that may persist for weeks or months, often resulting in disability. Existing treatments primarily consist of conservative interventions, including rest, nonsteroidal anti-inflammatory medications, localized corticosteroid injections, ultrasound, bracing, and stem cell-based therapies, as well as surgical procedures. However, therapeutic outcomes remain unsatisfactory. Consequently, there is an urgent need for effective strategies in tendinopathy management. As a bioengineered material, the hydrogel has been extensively studied for the treatment of tendinopathy due to its stable physicochemical properties, biocompatibility, degradability, mechanical robustness, injectability, and stimuli-responsive drug delivery capability. Based on the anatomical structure of tendons and therapeutic requirements during disease progression, hydrogels can be designed into various formulations, such as scaffolds, patches, sprays, microspheres, and injectable systems, depending on the raw materials, crosslinking methods, sizes, and morphological configuration. This review provides a comprehensive overview of the pathophysiological process involved in tendon healing and summarizes the considerations in the design of hydrogels in tendinopathy treatment. It emphasizes the therapeutic applications and stimuli-responsive properties of various hydrogel formulations in tendinopathy treatment, advancing the understanding of hydrogel-based strategies for tendinopathy management and focusing on formulation design. Additionally, the opportunities artificial intelligence brings to hydrogel research in design, optimization, and application advancement are also comprehensively discussed. Understanding the advances associated with hydrogel development is crucial for tendinopathy treatment.