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Zhang Q, Yang X, Wang K, Xu Z, Liu W. A High-Density Hydrogen Bond Locking Strategy for Constructing Anisotropic High-Strength Hydrogel-Based Meniscus Substitute. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2310035. [PMID: 38509852 PMCID: PMC11165514 DOI: 10.1002/advs.202310035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/25/2024] [Indexed: 03/22/2024]
Abstract
Mimicking anisotropic features is crucial for developing artificial load-bearing soft tissues such as menisci). Here, a high-density hydrogen bond locking (HDHBL) strategy, involving preloading a poly(N-acryloylsemicarbazide) (PNASC) hydrogel with an aqueous solution containing a hydrogen bond breaking agent, followed by water exchange, to fabricate anisotropic high-strength hydrogels are proposed. During this process, multiple high-density hydrogen bonds of the PNASC network are re-established, firmly freezing oriented molecular chains, and creating a network with an anisotropic microstructure. The resulting anisotropic hydrogels exhibit superior mechanical properties: tensile strength over 9 MPa, Young's modulus exceeding 120 MPa along the orientation direction, and fatigue thresholds exceeding 1900 J m-2. These properties meet the mechanical demands for load-bearing tissue substitutes compared to other reported anti-fatigue hydrogels. This strategy enables the construction of an anisotropic meniscal scaffold composed of circumferentially oriented microfibers by preloading a digital light processing-3D printed PNASC hydrogel-based wedge-shaped construct with a resilient poly(N-acryloyl glycinamide) hydrogel. The 12-week implantation of a meniscus scaffold in rabbit knee joints after meniscectomy demonstrates a chondroprotective effect on the femoral condyle and tibial plateau, substantially ameliorating the progression of osteoarthritis. The HDHBL strategy enables the fabrication of various anisotropic polymer hydrogels, broadening their scope of application.
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Affiliation(s)
- Qian Zhang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional MaterialsTianjin UniversityTianjin300350China
| | - Xuxuan Yang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional MaterialsTianjin UniversityTianjin300350China
| | - Kuan Wang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional MaterialsTianjin UniversityTianjin300350China
| | - Ziyang Xu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional MaterialsTianjin UniversityTianjin300350China
| | - Wenguang Liu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional MaterialsTianjin UniversityTianjin300350China
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Pawelec KM, Schoborg TA, Shapiro EM. Computed tomography technologies to measure key structural features of polymeric biomedical implants from bench to bedside. J Biomed Mater Res A 2024. [PMID: 38728118 DOI: 10.1002/jbm.a.37735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/11/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
Implanted polymeric devices, designed to encourage tissue regeneration, require porosity. However, characterizing porosity, which affects many functional device properties, is non-trivial. Computed tomography (CT) is a quick, versatile, and non-destructive way to gain 3D structural information, yet various CT technologies, such as benchtop, preclinical and clinical systems, all have different capabilities. As system capabilities determine the structural information that can be obtained, seamless monitoring of key device features through all stages of clinical translation must be engineered intentionally. Therefore, in this study we tested feasibility of obtaining structural information in pre-clinical systems and high-resolution micro-CT (μCT) under physiological conditions. To overcome the low CT contrast of polymers in hydrated environments, radiopaque nanoparticle contrast agent was incorporated into porous devices. The size of resolved features in porous structures is highly dependent on the resolution (voxel size) of the scan. As the voxel size of the CT scan increased (lower resolution) from 5 to 50 μm, the measured pore size was overestimated, and percentage porosity was underestimated by nearly 50%. With the homogeneous introduction of nanoparticles, changes to device structure could be quantified in the hydrated state, including at high-resolution. Biopolymers had significant structural changes post-hydration, including a mean increase of 130% in pore wall thickness that could potentially impact biological response. By incorporating imaging capabilities into polymeric devices, CT can be a facile way to monitor devices from initial design stages through to clinical translation.
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Affiliation(s)
- Kendell M Pawelec
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
- Institute for Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Todd A Schoborg
- Department of Molecular Biology, University of Wyoming, Laramie, Wyoming, USA
| | - Erik M Shapiro
- Department of Radiology, Michigan State University, East Lansing, Michigan, USA
- Institute for Quantitative Health Sciences and Engineering, Michigan State University, East Lansing, Michigan, USA
- Department of Physiology, Michigan State University, East Lansing, Michigan, USA
- Department of Chemical Engineering and Material Science, Michigan State University, East Lansing, Michigan, USA
- Department of Biomedical Engineering, Michigan State University, East Lansing, Michigan, USA
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Yoon KH, Kim JG, Wang JH, Lee JH, Park CH. Collagen Meniscal Scaffold Implantation Can Provide Meniscal Regeneration in Asian Patients with Partial Meniscal Defects: A Prospective Randomized Controlled Study with Three-Dimensional Volume Analysis of the Meniscus. Clin Orthop Surg 2024; 16:275-285. [PMID: 38562624 PMCID: PMC10973619 DOI: 10.4055/cios24062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Background To date, the efficiency of collagen meniscal scaffold implantation in Asian patients with partial meniscal defects has not been evaluated. In addition, no study has quantitatively analyzed meniscal regeneration using three-dimensional (3D) volume analysis after collagen scaffold implantation. We aimed to compare meniscal regeneration using 3D volume analysis between Asian patients undergoing collagen-based meniscal scaffold implantation after partial meniscectomy and those undergoing only partial meniscectomy. Methods Nineteen patients who underwent collagen-based meniscal scaffold implantation and 14 who underwent partial meniscectomy were analyzed with a prospective randomized control design for 12 months postoperatively. The demographic characteristics, Kellgren-Lawrence grade, and location of the injury lesion (medial or lateral meniscus) were not significantly different between the groups. Using 3D volume analysis with magnetic resonance imaging (MRI), the meniscus-removing ratio during the operative procedure and the meniscus defect-filling ratio were measured during the 12-month postoperative period. Clinically, the visual analog scale, International Knee Documentation Committee score, and Knee Injury and Osteoarthritis Outcome Score were evaluated. The Whole-Organ Magnetic Resonance Imaging Score (WORMS) and Genovese grade were also evaluated using MRI. Results In the 3D volume analysis, the average meniscus-removing ratio during surgery was not significantly different between the groups (-9.3% vs. -9.2%, p = 0.984). The average meniscus defect-filling ratio during the postoperative 12-month period was 7.5% in the scaffold group and -0.4% in the meniscectomy group (p < 0.001). None of the clinical results were significantly different between the scaffold and meniscectomy groups at 12 months postoperatively. The average change in the total WORMS score was not significantly different between the groups (0 vs. 1.9, p = 0.399). The Genovese grade of the implanted collagen scaffold did not significantly change during the follow-up period in terms of morphology and size (p = 0.063); however, the grade significantly improved in terms of signal intensity (p = 0.001). Conclusions Definite meniscal regeneration and stable scaffold incorporation were observed after collagen-based meniscal scaffold implantation in Asian patients during 12 months of follow-up. A long-term follow-up study with a larger cohort is required to determine the advantages of collagenous meniscal scaffold implantation in Asian patients.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Korea
| | - Jun Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Orthopaedic Surgery, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
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Torres-Claramunt R, Martínez-Díaz S, Sánchez-Soler JF, Tio-Barrera L, Arredondo R, Triginer L, Monllau JC. Fibronectin-coated polyurethane meniscal scaffolding supplemented with MSCs improves scaffold integration and proteoglycan production in a rabbit model. Knee Surg Sports Traumatol Arthrosc 2023; 31:5104-5110. [PMID: 37725106 DOI: 10.1007/s00167-023-07562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE The role of mesenchymal stem cells (MSC) in supporting the formation of new meniscal tissue in a meniscal scaffold is not well understood. The objective of this study was to assess the quality of the meniscal tissue produced in a fibronectin (FN)-coated polyurethane (PU) meniscal scaffold after a meniscal injury was made in an experimental rabbit model. METHODS Twelve New Zealand white rabbits were divided in two groups after performing a medial meniscectomy of the anterior horn. In group 1, the meniscal defect was reconstructed with a non-MSC supplemented FN-coated PU scaffold. On the other hand, the same scaffold supplemented with MSCs was used in group 2. The animals were sacrificed at 12 week after index surgery. A modified scoring system was used for histological assessment. This new scoring (ranging from 0 to 15) includes a structural evaluation (meniscal scaffold interface and extracellular matrix production) and tissue quality evaluation (proteoglycan and type I-collagen content). RESULTS The meniscal scaffold was found loose in the joint in three cases, corresponding to two cases in group 1 and 1 case in group 2. No differences were observed between the groups in terms of the total score (7.0 ± 0.9 vs. 9.4 ± 2.6, p = 0.09). However, differences were observed in group 2 in which 2 out of the 5 scored items, scaffold integration (1 ± 0.0 vs. 1.9 ± 0.6, p = 0.03) and proteoglycan production (1.2 ± 0.3 vs. 2.4 ± 0.2, p = 0.001). A trend to a higher production of Type I-Collagen production was also observed in group 2 (1.1 ± 0.4 vs. 1.4 ± 0.7, p = 0.05). CONCLUSION In a rabbit model at 12 weeks, the adhesion of MSCs to a FN-coated PU scaffold improves scaffold integration, proteoglycan production and the characteristics of the new meniscal-like tissue obtained when compared to a non-supplemented scaffold. This fact could be a major step toward improving the adhesion of the MSCs to meniscal scaffolds and, consequently, the obtention of better quality meniscal tissue.
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Affiliation(s)
- Raúl Torres-Claramunt
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain.
- IMIM (Hospital del Mar Medical Research Institute), C/Dr. Aiguader 88, 08003, Barcelona, Spain.
- Orthopaedic Department, ICATME-Institut Universitari Quirón-Dexeus, Universitat Autònoma Barcelona, C/ Sabino de Arana 5-19, 08028, Barcelona, Spain.
| | - Santos Martínez-Díaz
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), C/Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Juan F Sánchez-Soler
- Orthopaedic Department, Hospital del Mar, Universitat Autònoma Barcelona, Passeig Marítim de la Barceloneta 25-29, 08003, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), C/Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Laura Tio-Barrera
- IMIM (Hospital del Mar Medical Research Institute), C/Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Raquel Arredondo
- IMIM (Hospital del Mar Medical Research Institute), C/Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Laura Triginer
- IMIM (Hospital del Mar Medical Research Institute), C/Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Joan C Monllau
- IMIM (Hospital del Mar Medical Research Institute), C/Dr. Aiguader 88, 08003, Barcelona, Spain
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Dabaghi M, Eras V, Kaltenhaeuser D, Ahmed N, Wildemann B. Allografts for partial meniscus repair: an in vitro and ex vivo meniscus culture study. Front Bioeng Biotechnol 2023; 11:1268176. [PMID: 37901839 PMCID: PMC10603185 DOI: 10.3389/fbioe.2023.1268176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/11/2023] [Indexed: 10/31/2023] Open
Abstract
The purpose of this study was to evaluate the treatment potential of a human-derived demineralized scaffold, Spongioflex® (SPX), in partial meniscal lesions by employing in vitro models. In the first step, the differentiation potential of human meniscal cells (MCs) was investigated. In the next step, the ability of SPX to accommodate and support the adherence and/or growth of MCs while maintaining their fibroblastic/chondrocytic properties was studied. Control scaffolds, including bovine collagen meniscus implant (CMI) and human meniscus allograft (M-Allo), were used for comparison purposes. In addition, the migration tendency of MCs from fresh donor meniscal tissue into SPX was investigated in an ex vivo model. The results showed that MCs cultured in osteogenic medium did not differentiate into osteogenic cells or form significant calcium phosphate deposits, although AP activity was relatively increased in these cells. Culturing cells on the scaffolds revealed increased viability on SPX compared to the other scaffold materials. Collagen I synthesis, assessed by ELISA, was similar in cells cultured in 2D and on SPX. MCs on micro-porous SPX (weight >0.5 g/cm3) exhibited increased osteogenic differentiation indicated by upregulated expression of ALP and RUNX2, while also showing upregulated expression of the chondrogen-specific SOX9 and ACAN genes. Ingrowth of cells on SPX was observed after 28 days of cultivation. Overall, the results suggest that SPX could be a promising biocompatible scaffold for meniscal regeneration.
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Affiliation(s)
- Mohammad Dabaghi
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Volker Eras
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Berlin, Germany
| | - Daniel Kaltenhaeuser
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Berlin, Germany
| | - Norus Ahmed
- German Institute for Cell and Tissue Replacement (DIZG, gemeinnützige GmbH), Berlin, Germany
| | - Britt Wildemann
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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Zhang X, Furumatsu T, Hiranaka T, Okazaki Y, Xue H, Kintaka K, Miyazawa S, Ozaki T. The stability of repaired meniscal root can affect postoperative cartilage status following medial meniscus posterior root repair. J Orthop Sci 2023; 28:1060-1067. [PMID: 36089432 DOI: 10.1016/j.jos.2022.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/15/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transtibial pullout repair yields beneficial clinical outcomes in patients with medial meniscus (MM) posterior root tear. However, the relationship between repaired meniscal root healing status and postoperative clinical outcomes remains unclear. We aimed to evaluate changes in articular cartilage damage and clinical scores after pullout repair using two simple stitches (TSS). METHODS Thirty-three patients who underwent pullout repair using TSS were assessed. Healing status was assessed by a semi-quantitative second-look arthroscopic scoring system comprising three evaluation criteria (width of bridging tissues, stability of the repaired root, and synovial coverage), 1 year postoperatively. MM medial extrusion (MMME) and cartilage damage were assessed preoperatively and 1 year postoperatively. The medial compartment was divided into 8 zones (A-H) for comparison of preoperative and 1-year postoperative cartilage damage. Clinical outcomes were evaluated using the Knee Injury and Osteoarthritis Outcome score, Lysholm score, International Knee Documentation Committee scores, and visual analogue scale pain score. RESULTS Although cartilage damage did not aggravate significantly in most medial compartment areas, MMME progressed at 1 year postoperatively. No statistical differences were observed in cartilage damage between the central-to-medial area of the medial femoral condyle and the medial tibial plateau area at 1 year postoperatively. Regarding semi-quantitative healing scores, the stability score was significantly correlated with the International Cartilage Repair Society grade at 1 year postoperatively. All 1-year and 2-year clinical scores significantly improved compared with the preoperative scores. CONCLUSION Regarding TSS repair, stability of repaired meniscal root negatively correlated with cartilage damage in the medial compartment loading area. All 1-year and 2-year clinical scores significantly improved than those of the preoperative scores. Achieving MM stability is crucial for suppressing cartilage degeneration. LEVEL OF EVIDENCE IV case series study.
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Affiliation(s)
- Ximing Zhang
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan.
| | - Takaaki Hiranaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Yuki Okazaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Haowei Xue
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Keisuke Kintaka
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Shinichi Miyazawa
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikatacho, Kitaku, Okayama 700-8558, Japan
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Peng Y, Lu M, Zhou Z, Wang C, Liu E, Zhang Y, Liu T, Zuo J. Natural biopolymer scaffold for meniscus tissue engineering. Front Bioeng Biotechnol 2022; 10:1003484. [PMID: 36246362 PMCID: PMC9561892 DOI: 10.3389/fbioe.2022.1003484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/16/2022] [Indexed: 11/26/2022] Open
Abstract
Meniscal injuries caused by trauma, degeneration, osteoarthritis, or other diseases always result in severe joint pain and motor dysfunction. Due to the unique anatomy of the human meniscus, the damaged meniscus lacks the ability to repair itself. Moreover, current clinical treatments for meniscal injuries, including meniscal suturing or resection, have significant limitations and drawbacks. With developments in tissue engineering, biopolymer scaffolds have shown promise in meniscal injury repair. They act as templates for tissue repair and regeneration, interacting with surrounding cells and providing structural support for newly formed meniscal tissue. Biomaterials offer tremendous advantages in terms of biocompatibility, bioactivity, and modifiable mechanical and degradation kinetics. In this study, the preparation and composition of meniscal biopolymer scaffolds, as well as their properties, are summarized. The current status of research and future research prospects for meniscal biopolymer scaffolds are reviewed in terms of collagen, silk, hyaluronic acid, chitosan, and extracellular matrix (ECM) materials. Overall, such a comprehensive summary provides constructive suggestions for the development of meniscal biopolymer scaffolds in tissue engineering.
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Affiliation(s)
- Yachen Peng
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Meng Lu
- Department of Nursing, The First Bethune Hospital of Jilin University, Changchun, China
| | - Zhongsheng Zhou
- Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chenyu Wang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Enbo Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yanbo Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Yanbo Zhang, ; Tong Liu, ; Jianlin Zuo,
| | - Tong Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Yanbo Zhang, ; Tong Liu, ; Jianlin Zuo,
| | - Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Yanbo Zhang, ; Tong Liu, ; Jianlin Zuo,
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Long sports career and satisfactory clinical outcomes after Meniscal Allograft Transplantation (MAT) in young professional athletes involved in strenuous sports. Knee Surg Sports Traumatol Arthrosc 2022; 30:2314-2319. [PMID: 34812916 DOI: 10.1007/s00167-021-06779-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/18/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the return to sport rate of young professional athletes, to analyze their careers in terms of matches played and league participation over a minimum period of 6 years after Meniscal Allograft Transplantation (MAT), as well as to assess the long-term clinical subjective outcomes and satisfaction. METHODS Thirteen professional athletes (ten soccer and one basketball players, one fencer and one wrestler) with a mean age at surgery of 23.4 ± 4.0 underwent MAT (six medial, seven lateral). The time required to return to sport, post-operative performance level and the number of reoperations were evaluated. At an average follow-up of 9.0 ± 2.8 years, Lysholm, KOOS and Cincinnati scores were administered and collected. RESULTS Thirteen patients (100%) returned to sports practice after an average period of 11.8 ± 3.8 months. Nine athletes (69%) returned to sports at the same pre-injury level. Overall, 93%, 85%, 62% and 55% were active until the 3rd, the 5th, the 7th and the 9th season after MAT, respectively. Seven patients (54%) underwent a reoperation after MAT, where only two of them (15%) were related to graft problems (one meniscectomy and one graft suture). Of the ten athletes that completed subjective evaluation, the mean Lysholm score was 72 ± 15 (0% "Excellent", 10% "Good", 60% "Fair", 30% "Poor"). Of the athletes with lower scores, one suffered from patellar tendon rupture, one from post-operative infection and one from a previous femoral fracture. The mean Cincinnati knee score was 77 ± 18, while the average KOOS values were 60 ± 34 for sports. CONCLUSION Meniscal Allograft Transplantation (MAT) in young professional athletes involved in strenuous activities allowed all patients to return to pre-injury sport and in nearly 70% of cases at their pre-injury level. After five seasons following MAT, 85% of patients were still active or playing more than 20-30 matches per season. On the other hand, nearly 50% underwent at least one reoperation and only 70% of patients were rated as "Good", or "Fair" using the Lysholm score. LEVEL OF EVIDENCE IV.
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Di Matteo B, Anzillotti G, Kon E. Navigating around the Current Options to Preserve and Regenerate Meniscus: A Long Journey Still to Be Pursued. Int J Mol Sci 2022; 23:ijms23116057. [PMID: 35682735 PMCID: PMC9181105 DOI: 10.3390/ijms23116057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Berardo Di Matteo
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (B.D.M.); (E.K.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Giuseppe Anzillotti
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (B.D.M.); (E.K.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Correspondence:
| | - Elizaveta Kon
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (B.D.M.); (E.K.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
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Wang L, Jiang J, Lin H, Zhu T, Cai J, Su W, Chen J, Xu J, Li Y, Wang J, Zhang K, Zhao J. Advances in Regenerative Sports Medicine Research. Front Bioeng Biotechnol 2022; 10:908751. [PMID: 35646865 PMCID: PMC9136559 DOI: 10.3389/fbioe.2022.908751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023] Open
Abstract
Regenerative sports medicine aims to address sports and aging-related conditions in the locomotor system using techniques that induce tissue regeneration. It also involves the treatment of meniscus and ligament injuries in the knee, Achilles’ tendon ruptures, rotator cuff tears, and cartilage and bone defects in various joints, as well as the regeneration of tendon–bone and cartilage–bone interfaces. There has been considerable progress in this field in recent years, resulting in promising steps toward the development of improved treatments as well as the identification of conundrums that require further targeted research. In this review the regeneration techniques currently considered optimal for each area of regenerative sports medicine have been reviewed and the time required for feasible clinical translation has been assessed. This review also provides insights into the direction of future efforts to minimize the gap between basic research and clinical applications.
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Affiliation(s)
- Liren Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People’ Hospital, Shanghai, China
| | - Hai Lin
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Tonghe Zhu
- School of Chemistry and Chemical Engineering, Shanghai Engineering Research Center of Pharmaceutical Intelligent Equipment, Shanghai Frontiers Science Research Center for Druggability of Cardiovascular Non-Coding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, Shanghai, China
| | - Jiangyu Cai
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yamin Li
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jing Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Kai Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- *Correspondence: Kai Zhang, ; Jinzhong Zhao,
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People’ Hospital, Shanghai, China
- *Correspondence: Kai Zhang, ; Jinzhong Zhao,
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11
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Pedersen DD, Kim S, Wagner WR. Biodegradable polyurethane scaffolds in regenerative medicine: Clinical translation review. J Biomed Mater Res A 2022; 110:1460-1487. [PMID: 35481723 DOI: 10.1002/jbm.a.37394] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 12/14/2022]
Abstract
Early explorations of tissue engineering and regenerative medicine concepts commonly utilized simple polyesters such as polyglycolide, polylactide, and their copolymers as scaffolds. These biomaterials were deemed clinically acceptable, readily accessible, and provided processability and a generally known biological response. With experience and refinement of approaches, greater control of material properties and integrated bioactivity has received emphasis and a broadened palette of synthetic biomaterials has been employed. Biodegradable polyurethanes (PUs) have emerged as an attractive option for synthetic scaffolds in a variety of tissue applications because of their flexibility in molecular design and ability to fulfill mechanical property objectives, particularly in soft tissue applications. Biodegradable PUs are highly customizable based on their composition and processability to impart tailored mechanical and degradation behavior. Additionally, bioactive agents can be readily incorporated into these scaffolds to drive a desired biological response. Enthusiasm for biodegradable PU scaffolds has soared in recent years, leading to rapid growth in the literature documenting novel PU chemistries, scaffold designs, mechanical properties, and aspects of biocompatibility. Despite the enthusiasm in the field, there are still few examples of biodegradable PU scaffolds that have achieved regulatory approval and routine clinical use. However, there is a growing literature where biodegradable PU scaffolds are being specifically developed for a wide range of pathologies and where relevant pre-clinical models are being employed. The purpose of this review is first to highlight examples of clinically used biodegradable PU scaffolds, and then to summarize the growing body of reports on pre-clinical applications of biodegradable PU scaffolds.
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Affiliation(s)
- Drake D Pedersen
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Seungil Kim
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William R Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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Deng X, Chen X, Geng F, Tang X, Li Z, Zhang J, Wang Y, Wang F, Zheng N, Wang P, Yu X, Hou S, Zhang W. Precision 3D printed meniscus scaffolds to facilitate hMSCs proliferation and chondrogenic differentiation for tissue regeneration. J Nanobiotechnology 2021; 19:400. [PMID: 34856996 PMCID: PMC8641190 DOI: 10.1186/s12951-021-01141-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background The poor regenerative capability and structural complexity make the reconstruction of meniscus particularly challenging in clinic. 3D printing of polymer scaffolds holds the promise of precisely constructing complex tissue architecture, however the resultant scaffolds usually lack of sufficient bioactivity to effectively generate new tissue. Results Herein, 3D printing-based strategy via the cryo-printing technology was employed to fabricate customized polyurethane (PU) porous scaffolds that mimic native meniscus. In order to enhance scaffold bioactivity for human mesenchymal stem cells (hMSCs) culture, scaffold surface modification through the physical absorption of collagen I and fibronectin (FN) were investigated by cell live/dead staining and cell viability assays. The results indicated that coating with fibronectin outperformed coating with collagen I in promoting multiple-aspect stem cell functions, and fibronectin favors long-term culture required for chondrogenesis on scaffolds. In situ chondrogenic differentiation of hMSCs resulted in a time-dependent upregulation of SOX9 and extracellular matrix (ECM) assessed by qRT-PCR analysis, and enhanced deposition of collagen II and aggrecan confirmed by immunostaining and western blot analysis. Gene expression data also revealed 3D porous scaffolds coupled with surface functionalization greatly facilitated chondrogenesis of hMSCs. In addition, the subcutaneous implantation of 3D porous PU scaffolds on SD rats did not induce local inflammation and integrated well with surrounding tissues, suggesting good in vivo biocompatibility. Conclusions Overall, this study presents an approach to fabricate biocompatible meniscus constructs that not only recapitulate the architecture and mechanical property of native meniscus, but also have desired bioactivity for hMSCs culture and cartilage regeneration. The generated 3D meniscus-mimicking scaffolds incorporated with hMSCs offer great promise in tissue engineering strategies for meniscus regeneration. Graphical Abstract ![]()
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Affiliation(s)
- Xingyu Deng
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
| | - Xiabin Chen
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
| | - Fang Geng
- Medtronic Technology Center, Shanghai, 201114, China
| | - Xin Tang
- Medtronic Technology Center, Shanghai, 201114, China
| | - Zhenzhen Li
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
| | - Jie Zhang
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China
| | - Yikai Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Hangzhou, Zhejiang Province, China
| | - Fangqian Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Hangzhou, Zhejiang Province, China
| | - Na Zheng
- State Key Laboratory of Chemical Engineering, School of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Peng Wang
- The State Key Laboratory of Translational Medicine and Innovative Drug Development, Nanjing, 210042, China
| | - Xiaohua Yu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China. .,Zhejiang Provincial Key Laboratory of Orthopaedics, Hangzhou, Zhejiang Province, China. .,Orthopedics Research Institute of Zhejiang University, Hangzhou, 310009, Zhejiang Province, China.
| | - Shurong Hou
- School of Pharmacy, Hangzhou Normal University, Hangzhou, 311121, Zhejiang, China.
| | - Wei Zhang
- Medtronic Technology Center, Shanghai, 201114, China.
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13
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Perera K, Ivone R, Natekin E, Wilga CA, Shen J, Menon JU. 3D Bioprinted Implants for Cartilage Repair in Intervertebral Discs and Knee Menisci. Front Bioeng Biotechnol 2021; 9:754113. [PMID: 34746106 PMCID: PMC8570130 DOI: 10.3389/fbioe.2021.754113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/30/2021] [Indexed: 01/10/2023] Open
Abstract
Cartilage defects pose a significant clinical challenge as they can lead to joint pain, swelling and stiffness, which reduces mobility and function thereby significantly affecting the quality of life of patients. More than 250,000 cartilage repair surgeries are performed in the United States every year. The current gold standard is the treatment of focal cartilage defects and bone damage with nonflexible metal or plastic prosthetics. However, these prosthetics are often made from hard and stiff materials that limits mobility and flexibility, and results in leaching of metal particles into the body, degeneration of adjacent soft bone tissues and possible failure of the implant with time. As a result, the patients may require revision surgeries to replace the worn implants or adjacent vertebrae. More recently, autograft - and allograft-based repair strategies have been studied, however these too are limited by donor site morbidity and the limited availability of tissues for surgery. There has been increasing interest in the past two decades in the area of cartilage tissue engineering where methods like 3D bioprinting may be implemented to generate functional constructs using a combination of cells, growth factors (GF) and biocompatible materials. 3D bioprinting allows for the modulation of mechanical properties of the developed constructs to maintain the required flexibility following implantation while also providing the stiffness needed to support body weight. In this review, we will provide a comprehensive overview of current advances in 3D bioprinting for cartilage tissue engineering for knee menisci and intervertebral disc repair. We will also discuss promising medical-grade materials and techniques that can be used for printing, and the future outlook of this emerging field.
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Affiliation(s)
- Kalindu Perera
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, United States
| | - Ryan Ivone
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, United States
| | - Evelina Natekin
- Department of Biological Sciences, University of Alaska Anchorage, Anchorage, AK, United States
| | - Cheryl. A. Wilga
- Department of Biological Sciences, University of Rhode Island, Kingston, RI, United States
- Department of Electrical, Computer and Biomedical Engineering, University of Rhode Island, Kingston, RI, United States
| | - Jie Shen
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, United States
- Department of Chemical Engineering, University of Rhode Island, Kingston, RI, United States
| | - Jyothi U. Menon
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, United States
- Department of Chemical Engineering, University of Rhode Island, Kingston, RI, United States
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14
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Troy E, Tilbury MA, Power AM, Wall JG. Nature-Based Biomaterials and Their Application in Biomedicine. Polymers (Basel) 2021; 13:3321. [PMID: 34641137 PMCID: PMC8513057 DOI: 10.3390/polym13193321] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 02/07/2023] Open
Abstract
Natural polymers, based on proteins or polysaccharides, have attracted increasing interest in recent years due to their broad potential uses in biomedicine. The chemical stability, structural versatility, biocompatibility and high availability of these materials lend them to diverse applications in areas such as tissue engineering, drug delivery and wound healing. Biomaterials purified from animal or plant sources have also been engineered to improve their structural properties or promote interactions with surrounding cells and tissues for improved in vivo performance, leading to novel applications as implantable devices, in controlled drug release and as surface coatings. This review describes biomaterials derived from and inspired by natural proteins and polysaccharides and highlights their promise across diverse biomedical fields. We outline current therapeutic applications of these nature-based materials and consider expected future developments in identifying and utilising innovative biomaterials in new biomedical applications.
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Affiliation(s)
- Eoin Troy
- Microbiology, College of Science and Engineering, National University of Ireland, NUI Galway, H91 TK33 Galway, Ireland; (E.T.); (M.A.T.)
| | - Maura A. Tilbury
- Microbiology, College of Science and Engineering, National University of Ireland, NUI Galway, H91 TK33 Galway, Ireland; (E.T.); (M.A.T.)
- SFI Centre for Medical Devices (CÚRAM), NUI Galway, H91 TK33 Galway, Ireland
| | - Anne Marie Power
- Zoology, School of Natural Sciences, NUI Galway, H91 TK33 Galway, Ireland;
| | - J. Gerard Wall
- Microbiology, College of Science and Engineering, National University of Ireland, NUI Galway, H91 TK33 Galway, Ireland; (E.T.); (M.A.T.)
- SFI Centre for Medical Devices (CÚRAM), NUI Galway, H91 TK33 Galway, Ireland
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