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Topic:Tendons

Tendons in horses are fibrous connective tissues that attach muscles to bones, facilitating movement and providing stability to the musculoskeletal system. They are composed primarily of collagen fibers, which confer strength and flexibility, allowing horses to perform various physical activities. Equine tendons are subject to significant mechanical stress during locomotion, making them susceptible to injury, particularly in performance horses. Common tendon injuries include strains, tears, and tendinitis, which can impact a horse's mobility and performance. This page compiles peer-reviewed research studies and scholarly articles that explore the structure, function, and pathology of tendons in horses, as well as advancements in diagnostic and therapeutic approaches for tendon injuries.
The equine navicular apparatus as a premier enthesis organ: Functional implications.
Veterinary surgery : VS    March 12, 2021   Volume 50, Issue 4 713-728 doi: 10.1111/vsu.13620
Osborn ML, Cornille JL, Blas-Machado U, Uhl EW.Navicular syndrome has been traditionally characterized by progressive lameness with chronic degeneration of the navicular bone. Advances in imaging techniques have revealed that its associated soft tissue structures are also affected. This distribution of lesions is explained by conceptualizing the equine navicular apparatus as an enthesis organ that facilitates the dissemination of mechanical stress throughout the tissues of the foot. The navicular apparatus has the same structural adaptations to mechanical stress as the human Achilles tendon complex. These adaptations efficiently dissipate ...
Minimally invasive tenotomy of the tibial insertion of the semitendinosus muscle: An ex vivo study in horses.
Veterinary surgery : VS    March 11, 2021   Volume 50, Issue 4 843-847 doi: 10.1111/vsu.13609
Zetterström SM, Boone LH, Weatherall KM, Caldwell FJ.To describe a minimally invasive technique for semitendinosus tenotomy with ultrasonographic guidance and to evaluate procedural complications. Methods: Experimental study. Methods: Cadaveric equine hind limbs (n = 16). Methods: A stab incision was performed distocaudal to the tibial insertion of the semitendinosus muscle with ultrasonographic assistance. After transection of the tendon with an arthroscopic retrograde knife, the tendon edges palpably retracted, and complete transection was confirmed by ultrasound. Limbs were dissected to confirm the degree of tendon transection and to identify...
The Evaluation of Equine Allogeneic Tenogenic Primed Mesenchymal Stem Cells in a Surgically Induced Superficial Digital Flexor Tendon Lesion Model.
Frontiers in veterinary science    March 5, 2021   Volume 8 641441 doi: 10.3389/fvets.2021.641441
Depuydt E, Broeckx SY, Van Hecke L, Chiers K, Van Brantegem L, van Schie H, Beerts C, Spaas JH, Pille F, Martens A. Tendon injuries are very common in horses and jeopardize the athletic performance, and due to the high risk of reinjury may lead to early retirement. The use of mesenchymal stem cells for the treatment of equine tendon disease is widely investigated because of their regenerative potential. The objective of this study is to investigate the safety and efficacy of equine allogeneic tenogenic primed mesenchymal stem cells (tpMSCs) for the management of tendinitis in horses. A core lesion was surgically induced in the superficial digital flexor tendon of both forelimbs of eight horses. After 7 da...
Equine Tenocyte Seeding on Gelatin Hydrogels Improves Elongated Morphology.
Polymers    February 28, 2021   Volume 13, Issue 5 747 doi: 10.3390/polym13050747
Meeremans M, Van Damme L, De Spiegelaere W, Van Vlierberghe S, De Schauwer C.(1) Background: Tendinopathy is a common injury in both human and equine athletes. Representative in vitro models are mandatory to facilitate translation of fundamental research into successful clinical treatments. Natural biomaterials like gelatin provide favorable cell binding characteristics and are easily modifiable. In this study, methacrylated gelatin (gel-MA) and norbornene-functionalized gelatin (gel-NB), crosslinked with 1,4-dithiotreitol (DTT) or thiolated gelatin (gel-SH) were compared. (2) Methods: The physicochemical properties (H-NMR spectroscopy, gel fraction, swelling ratio, an...
Syndromic clubfoot beyond arthrogryposis and myelomeningocele: orthopedic treatment with Ponseti method.
Revista espanola de cirugia ortopedica y traumatologia (English ed.)    February 26, 2021   Volume 65, Issue 3 180-185 doi: 10.1016/j.recot.2020.09.005
Ferrando Meseguer E, Roig Sánchez S, Pino Almero L, Romano Bataller A, Mínguez Rey MF.Talipes equinovarus or clubfoot is a congenital deformity of the foot with bone, muscle, and tendon involvement. It's one of the most frequent foot malformations in pediatric orthopedics. Although generally idiopathic, it may have a syndromic cause and be associated with musculoskeletal, neurological, or connective tissue conditions. The treatment of choice in idiopathic clubfoot is the Ponseti method based on manipulation and fixation with serial casts that seek progressive correction of the deformity. The Ponseti method effectiveness has been demonstrated in arthrogryposis and myelomeningoce...
Training Young Horses: The Science behind the Benefits.
Animals : an open access journal from MDPI    February 9, 2021   Volume 11, Issue 2 463 doi: 10.3390/ani11020463
Logan AA, Nielsen BD.Conflicting research and anecdotal evidence have created disagreement among equestrians as to whether two-year-old horses should be trained and raced. The objective of this literature review is to evaluate epidemiological studies, as well as physiological data on equine bone, articular cartilage, and tendons to better determine the impact of training and racing two-year-old horses. The evaluation of numerous studies on the topic provides evidence that a horse which is trained or raced as a two-year-old has a lower risk of injury and better adapted tissues for the rigors of racing. Unfortunatel...
Regenerative Medicine for Equine Musculoskeletal Diseases.
Animals : an open access journal from MDPI    January 19, 2021   Volume 11, Issue 1 234 doi: 10.3390/ani11010234
Ribitsch I, Oreff GL, Jenner F.Musculoskeletal injuries and chronic degenerative diseases commonly affect both athletic and sedentary horses and can entail the end of their athletic careers. The ensuing repair processes frequently do not yield fully functional regeneration of the injured tissues but biomechanically inferior scar or replacement tissue, causing high reinjury rates, degenerative disease progression and chronic morbidity. Regenerative medicine is an emerging, rapidly evolving branch of translational medicine that aims to replace or regenerate cells, tissues, or organs to restore or establish normal function. It...
Comparative Analysis of Tenogenic Gene Expression in Tenocyte-Derived Induced Pluripotent Stem Cells and Bone Marrow-Derived Mesenchymal Stem Cells in Response to Biochemical and Biomechanical Stimuli.
Stem cells international    January 13, 2021   Volume 2021 8835576 doi: 10.1155/2021/8835576
Yang F, Richardson DW.The tendon is highly prone to injury, overuse, or age-related degeneration in both humans and horses. Natural healing of injured tendon is poor, and cell-based therapeutic treatment is still a significant clinical challenge. In this study, we extensively investigated the expression of tenogenic genes in equine bone marrow mesenchymal stem cells (BMSCs) and tenocyte-derived induced pluripotent stem cells (teno-iPSCs) stimulated by growth factors (TGF-3 and BMP12) combined with ectopic expression of tenogenic transcription factor MKX or cyclic uniaxial mechanical stretch. Western blotting reveal...
Navicular Syndrome-related changes to collagen proportion of different cross-sections of the flexor tendons in equine distal forelimb.
Research in veterinary science    January 5, 2021   Volume 135 106-112 doi: 10.1016/j.rvsc.2021.01.002
Salinas P, Lira-Velásquez D, Bongiorno A, Sandoval C.The aim of this study was to quantify the distribution of aligned and non-aligned collagen in cross-sections of the superficial digital flexor tendon (SDFT) and deep digital flexor tendon (DDFT) in different levels of the distal forelimb of equines diagnosed with NS (Navicular Syndrome). Sixty equine forelimbs were collected. Was compared two groups (NA, Not affected vs. NS-group) by t-Student. Diagnosis of NS was based on clinical and lameness examination, diagnostic analgesia and radiological findings. The proportion of aligned and non-aligned collagens at 2 levels for the SDFT and 3 levels ...
Extracorporeal Shock Wave Therapy Enhances the In Vitro Metabolic Activity and Differentiation of Equine Umbilical Cord Blood Mesenchymal Stromal Cells.
Frontiers in veterinary science    December 4, 2020   Volume 7 554306 doi: 10.3389/fvets.2020.554306
Salcedo-Jiménez R, Koenig JB, Lee OJ, Gibson TWG, Madan P, Koch TG.Extracorporeal shock wave therapy (ESWT) has been shown to induce different biological effects on a variety of cells, including regulation and stimulation of their function and metabolism. ESWT can promote different biological responses such as proliferation, migration, and regenerations of cells. Recent studies have shown that mesenchymal stromal cells (MSCs) secrete factors that enhance the regeneration of tissues, stimulate proliferation and differentiation of cells, and decrease inflammatory and immune reactions. Clinically, the combination of these two therapies has been used as a treatme...
Ultrastructural evidence for telocytes in equine tendon.
Journal of anatomy    October 18, 2020   Volume 238, Issue 3 527-535 doi: 10.1111/joa.13335
Luesma MJ, Cantarero I, Sánchez-Cano AI, Rodellar C, Junquera C.The three-dimensional ultrastructure of the tendon is complex. Two main cell types are classically supported: elongated tenocytes and ovoid tenoblasts. The existence of resident stem/progenitor cells in human and equine tendons has been demonstrated, but their location and relationship to tenoblasts and tenocytes remain unclear. Hence, in this work, we carried out an ultrastructural study of the equine superficial digital flexor tendon. Although the fine structure of tendons has been previously studied using electron microscopy, the presence of telocytes, a specific type of interstitial cell, ...
Adding exogenous biglycan or decorin improves tendon formation for equine peritenon and tendon proper cells in vitro.
BMC musculoskeletal disorders    September 23, 2020   Volume 21, Issue 1 627 doi: 10.1186/s12891-020-03650-2
Pechanec MY, Boyd TN, Baar K, Mienaltowski MJ.Tendon injuries amount to one of the leading causes of career-ending injuries in horses due to the inability for tendon to completely repair and the high reinjury potential. As a result, novel therapeutics are necessary to improve repair with the goal of decreasing leg lameness and potential reinjury. Small leucine-rich repeat proteoglycans (SLRPs), a class of regulatory molecules responsible for collagen organization and maturation, may be one such therapeutic to improve tendon repair. Before SLRP supplementation can occur in vivo, proper evaluation of the effect of these molecules in vitro n...
High-Power Laser Therapy Improves Healing of the Equine Suspensory Branch in a Standardized Lesion Model.
Frontiers in veterinary science    September 3, 2020   Volume 7 600 doi: 10.3389/fvets.2020.00600
Pluim M, Martens A, Vanderperren K, van Weeren R, Oosterlinck M, Dewulf J, Kichouh M, Van Thielen B, Koene MHW, Luciani A, Plancke L, Delesalle C.High-power laser therapy is often used as a treatment for human sport injuries but controlled standardized studies on its efficacy are lacking. The technique has also been introduced in the equine field and recently promising results were reported in a retrospective study focusing on 150 sporthorses suffering from tendinopathy and desmopathy of the SDFT, DDFT, suspensory ligament, and suspensory branches. The goal of the present study was to evaluate the effect of high-power laser in a standardized lesion model in horses. Lesions were created in all lateral suspensory branches of 12 warmblood ...
Ultrasonographic Appearance of Elbow Joints in a Population of Amiata Donkeys.
Journal of equine veterinary science    September 2, 2020   Volume 94 103242 doi: 10.1016/j.jevs.2020.103242
Nocera I, Aliboni B, Sgorbini M, Gracia-Calvo LA, Conte G, Ben David L, Citi S.Ultrasound (US) is a well-established technique for investigating joint diseases in horses, complementary to radiography. Few studies have been performed on the ultrasonographic aspect of the elbow joint in horses and no reports are available on donkeys. The aim of this study is to describe the ultrasonographic appearance of the elbow joint in healthy donkeys. Descriptive cohort study included 34 elbow joints, which were evaluated in 17 donkeys. Inclusion criteria included no lameness or musculoskeletal diseases in the donkeys. The structures evaluated were the lateral and medial collateral li...
Microdamage in the equine superficial digital flexor tendon.
Equine veterinary journal    September 2, 2020   Volume 53, Issue 3 417-430 doi: 10.1111/evj.13331
O'Brien C, Marr N, Thorpe C.The forelimb superficial digital flexor tendon (SDFT) is an energy-storing tendon that is highly susceptible to injury during activities such as galloping and jumping, such that it is one of the most commonly reported causes of lameness in the performance horse. This review outlines the biomechanical and biothermal effects of strain on the SDFT and how these contribute to the accumulation of microdamage. The effect of age-related alterations on strain response and subsequent injury risk is also considered. Given that tendon is a slowly healing and poorly regenerative tissue, prompt detection o...
Comparison of Tenocyte Populations from the Core and Periphery of Equine Tendons.
Journal of proteome research    September 2, 2020   Volume 19, Issue 10 4137-4144 doi: 10.1021/acs.jproteome.0c00591
Zhang C, Svensson RB, Montagna C, Carstensen H, Buhl R, Schoof EM, Kjaer M, Magnusson SP, Yeung CC.Tendon is a highly organized, dense connective tissue that has been demonstrated to have very little turnover. In spite of the low turnover, tendon can grow in response to loading, which may take place primarily at the periphery. Tendon injuries and recurrence of injuries are common in both humans and animals in sports. It is unclear why some areas of the tendon are more susceptible to such injuries and whether this is due to intrinsic regional differences in extracellular matrix (ECM) production or tissue turnover. This study aimed to compare populations of tenocytes derived from the tendon c...
Induction of tenogenic differentiation of equine adipose-derived mesenchymal stem cells by platelet-derived growth factor-BB and growth differentiation factor-6.
Molecular biology reports    September 1, 2020   Volume 47, Issue 9 6855-6862 doi: 10.1007/s11033-020-05742-7
Javanshir S, Younesi Soltani F, Dowlati G, Parham A, Naderi-Meshkin H.Managing tendon healing process is complicated mainly due to the limited regeneration capacity of tendon tissue. Mesenchymal stem cells (MSCs) have potential applications in regenerative medicine and have been considered for tendon repair and regeneration. This study aimed to evaluate the capacity of equine adipose tissue-derived cells (eASCs) to differentiate into tenocytes in response to platelet-derived growth factor-BB (PDGF-BB) and growth differentiation factor-6 (GDF-6) in vitro. Frozen characterized eASCS of 3 mares were thawed and the cells were expanded in basic culture medium (DMEM...
The transcription factor scleraxis differentially regulates gene expression in tenocytes isolated at different developmental stages.
Mechanisms of development    August 11, 2020   Volume 163 103635 doi: 10.1016/j.mod.2020.103635
Paterson YZ, Evans N, Kan S, Cribbs A, Henson FMD, Guest DJ.The transcription factor scleraxis (SCX) is expressed throughout tendon development and plays a key role in directing tendon wound healing. However, little is known regarding its role in fetal or young postnatal tendons, stages in development that are known for their enhanced regenerative capabilities. Here we used RNA-sequencing to compare the transcriptome of adult and fetal tenocytes following SCX knockdown. SCX knockdown had a larger effect on gene expression in fetal tenocytes, affecting 477 genes in comparison to the 183 genes affected in adult tenocytes, indicating that scleraxis-depend...
In vitro Effects of Methylprednisolone Acetate on Equine Deep Digital Flexor Tendon-Derived Cells.
Frontiers in veterinary science    August 5, 2020   Volume 7 486 doi: 10.3389/fvets.2020.00486
Sullivan SN, Altmann NN, Brokken MT, Durgam SS.Primary deep digital flexor tendon (DDFT) pathologies and those accompanying degenerative changes of navicular bone fibrocartilage are major causes of lameness associated with navicular disease. Intrasynovial corticosteroids are mainstay in the treatment due to the anti-inflammatory effects, but their effect on DDFT cell biosynthesis are unknown. The objective of this study was to investigate the effects of methylprednisolone acetate (MPA) on cells isolated from the dorsal fibrocartilaginous region of forelimb DDFTs (DDFT-derived cells) of 5 horses (aged 11-17 years). Non-adherent aggregate c...
Effects of High Intensity Laser Therapy in the Treatment of Tendon and Ligament Injuries in Performance Horses.
Animals : an open access journal from MDPI    July 31, 2020   Volume 10, Issue 8 doi: 10.3390/ani10081327
Zielińska P, Nicpoń J, Kiełbowicz Z, Soroko M, Dudek K, Zaborski D.The aim of this study was to evaluate the effects of high intensity laser therapy (HILT) on tendon and ligament injury treatment in horses. Twenty six horses with tendinopathies were randomly assigned to a HILT treated or to a non-treated group. Each horse was subjected to the same rehabilitation programme. Horses from the treatment group underwent a series of fifteen HILT treatments with the same parameters. Clinical and ultrasound assessments were performed by the same veterinarian and were carried out before (day 0), during (day 13-15) and after treatment (day 38-40). Clinical evaluation in...
Application of gene therapy in the treatment of superficial digital flexor tendon injury in horses.
Open veterinary journal    July 31, 2020   Volume 10, Issue 3 261-266 doi: 10.4314/ovj.v10i3.3
Aimaletdinov A, Mindubaeva G, Khalikova S, Kabwe E, Salmakova A, Alexandrova N, Rutland C, Rizvanov A, Zakirova E.Tendon injuries are one of the most common causes of orthopedic disorders in horses. Such injuries involve a long course of treatment and recovery. The most promising method of treating these injuries is the use of recombinant proteins and gene therapy. In this work, we evaluated the therapeutic efficacy of plasmid DNA (pDNA) containing two species-specific coding sequences, i.e. vascular endothelial growth factor 164 (VEGF164) and fibroblast growth factor 2 (FGF2), in the treatment of severe damage to the tendon of the superficial digital flexor. A pDNA construct was used to restore the damag...
Variation in the MRI signal intensity of naturally occurring equine superficial digital flexor tendinopathies over a 12-month period.
The Veterinary record    July 20, 2020   Volume 187, Issue 7 e53 doi: 10.1136/vr.105800
Berner D, Brehm W, Gerlach K, Offhaus J, Scharner D, Burk J.Signal intensity (SI) of equine tendinopathies in MRI differs between the superficial digital flexor tendon (SDFT) and the deep digital flexor tendon (DDFT). In DDFT lesions, short tau inversion recovery (STIR) SI decreases earlier than T2-weighted (T2w) SI, while the latter decreases earlier in SDFT lesions, but long-term results using STIR sequences are lacking. Methods: Standing MRI of eight horses with naturally occurring SDFT lesions was performed at the day of treatment as well as 2, 6 and 12 months after treatment. Results: After 12 months, six horses were sound and showed complete reso...
Biochemical differences between distal limb extensor and flexor tendons among equine breeds selected for racing and sport.
Veterinary journal (London, England : 1997)    July 10, 2020   Volume 262 105515 doi: 10.1016/j.tvjl.2020.105515
Verkade ME, Hazeleger E, van de Lest CHA, Back W.Throughout the ages, humans have selected different horse breeds for their locomotor capacities. Consequently, the properties of equine locomotor tissues could have diversified because of the specific requirements of different disciplines. Therefore, this study aimed to compare biochemical properties of tendons in different equine breeds traditionally selected for racing or sports performance. We hypothesised that tendons in racing breeds would have biochemical properties that would increase strength, whereas those in sporting breeds would have more elastic properties. An ex vivo tendon tissue...
Bimodal Whole-Mount Imaging of Tendon Using Confocal Microscopy and X-ray Micro-Computed Tomography.
Biological procedures online    July 1, 2020   Volume 22 13 doi: 10.1186/s12575-020-00126-4
Marr N, Hopkinson M, Hibbert AP, Pitsillides AA, Thorpe CT.Three-dimensional imaging modalities for optically dense connective tissues such as tendons are limited and typically have a single imaging methodological endpoint. Here, we have developed a bimodal procedure utilising fluorescence-based confocal microscopy and x-ray micro-computed tomography for the imaging of adult tendons to visualise and analyse extracellular sub-structure and cellular composition in small and large animal species. Results: Using fluorescent immunolabelling and optical clearing, we visualised the expression of the novel cross-species marker of tendon basement membrane, lam...
Relationships between morphometric measurements and musculoskeletal disorders in jumping Thoroughbred horses.
Journal of equine science    June 24, 2020   Volume 31, Issue 2 23-27 doi: 10.1294/jes.31.23
Mostafa MB, Elemmawy YM.There is limited knowledge about causes of musculoskeletal injury in jumping Thoroughbred horses. The objective of this study was to describe the relationships between musculoskeletal disorders and linear and angular limb measurements acquired from photographs of horses with markers at specific reference points. The diagnosed musculoskeletal disorders in either fore or hind limbs were flexor tendonitis, suspensory ligaments desmitis, and osteoarthritis of the distal intertarsal and tarso-metatarsal and carpometacarpal joints. Lengths and angles in 17 clinically normal jumping Thoroughbred hors...
High Frequencies of TNC and COL5A1 Genotypes Associated With Low Risk for Superficial Digital Flexor Tendinopathy in Greek Indigenous Horse Breeds Compared With Warmblood Horses.
Journal of equine veterinary science    June 20, 2020   Volume 92 103173 doi: 10.1016/j.jevs.2020.103173
Giantsis IA, Diakakis NE, Avdi M.Tendinopathies constitute a very common category of musculoskeletal disorders, causing economic losses in the equine industry and animal welfare issues in horse populations. Sport and racehorses are in general sensitive to tendinopathies, whereas local indigenous horse populations are often more tolerant to various disorders. Particularly, indigenous Greek horse breeds have evolved and adapted in the rough topographic features of mountainous and semimountainous Greek terrain and are less prone to develop tendinopathies. Susceptibility to tendinopathy has been proposed to be associated with thr...
Genetics of Equine Orthopedic Disease.
The Veterinary clinics of North America. Equine practice    June 11, 2020   Volume 36, Issue 2 289-301 doi: 10.1016/j.cveq.2020.03.008
Metzger J, Distl O.Orthopedic diseases are a common cause for limited exercise capacity in the horse. They often underlie genetic risk factors, which can affect bone, articular cartilage, tendons, ligaments, and adnexal structures among others. The genetic effects can directly interfere with tissue development and skeletal growth or can trigger degenerative or inflammatory processes. Many of these diseases of the locomotor system like osteochondrosis are complex and can be affected by multifactorial influences. For this reason, it is important for those performing diagnostic procedures to have a comprehensive kn...
Contrast therapy: Tissue heating and cooling properties within the equine distal limb.
Equine veterinary journal    May 29, 2020   Volume 53, Issue 1 149-156 doi: 10.1111/evj.13278
Haussler KK, Wilde SR, Davis MS, Hess AM, McIlwraith CW.Rehabilitation of tendon injuries in horses often involves cryotherapy to reduce inflammation and occasionally tissue heating to increase collagen extensibility. The application of alternating cold and hot (ie contrast therapy) is widely used in human physical therapy; however, its utility in equine rehabilitation is largely unknown. Objective: The objectives of this study were to (a) assess if the equipment could achieve therapeutic tissue temperatures (40°C) at different tissue depths relative to the digital flexor tendons and (b) evaluate the time-temperature profiles during serial heating...
Is the T-ligament a ligament? A histological study in equine cadaver forelimbs.
Research in veterinary science    May 23, 2020   Volume 132 10-16 doi: 10.1016/j.rvsc.2020.05.018
Hontoir F, Paques F, Simon V, Balau B, Nicaise C, Clegg P, Dugdale A, Vandeweerd JM.Foot pain is a frequent cause of lameness in horses and can involve multiple structures within the hoof. The T-ligament (an anatomical structure connecting the synovium of the distal interphalangeal joint, the digital flexor tendon sheath and the navicular bursa) is poorly described. Five pairs of equine cadaver distal forelimbs were collected from a slaughterhouse. Sagittal sections (medial, middle and lateral) were obtained and processed with Haematoxylin Eosin Safran, Unna's Orcein, and Picrosirius red stains. Histological assessment revealed that the T-ligament was covered by the surroundi...
Genome-wide transcriptome analysis reveals equine embryonic stem cell-derived tenocytes resemble fetal, not adult tenocytes.
Stem cell research & therapy    May 19, 2020   Volume 11, Issue 1 184 doi: 10.1186/s13287-020-01692-w
Paterson YZ, Cribbs A, Espenel M, Smith EJ, Henson FMD, Guest DJ.Tendon injuries occur frequently in human and equine athletes. Treatment options are limited, and the prognosis is often poor with functionally deficient scar tissue resulting. Fetal tendon injuries in contrast are capable of healing without forming scar tissue. Embryonic stem cells (ESCs) may provide a potential cellular therapeutic to improve adult tendon regeneration; however, whether they can mimic the properties of fetal tenocytes is unknown. To this end, understanding the unique expression profile of normal adult and fetal tenocytes is crucial to allow validation of ESC-derived tenocytes...
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