<p>Tendon adhesion, a prevalent complication affecting over 30% of patients after a tendon injury or surgery, results in joint stiffness and impaired mobility. Although current treatments facilitate tendon repair, they are often insufficient in preventing adhesions and promoting optimal healing outcomes. To address these challenges, we developed an oriented cryostructured silk fibroin bandage (OCSFB) using the directional freeze-casting methodology. In vitro studies demonstrated that OCSFB provided a favorable microenvironment for cell viability, proliferation, and alignment, concurrently upregulating the expression of tendon-specific genes. In a rat Achilles tendon model, OCSFB significantly reduced adhesion formation and improved tendon healing. RNA-seq analysis further revealed modulation of cell adhesion molecules, substantiating its role in tissue regeneration. The integration of silk fibroin biocompatibility with a unique microstructure that facilitates cellular adhesion and proliferation renders OCSFB a promising approach for mitigating tendon adhesions and improving repair outcomes, establishing it as a robust candidate for clinical application.</p>