Repair of osteochondral defects in the knee by resorbable bioimplants in a rabbit model

Additive Manufacturing of Polymer/Bioactive Glass Scaffolds for Regenerative Medicine: A Review

Tissue engineering (TE) is a branch of regenerative medicine with enormous potential to regenerate damaged tissues using synthetic grafts such as scaffolds. Polymers and bioactive glasses (BGs) are popular materials for scaffold production because of their tunable properties and ability to interact with the body for effective tissue regeneration. Due to their composition and amorphous structure, BGs possess a significant affinity with the recipient's tissue. Additive manufacturing (AM), a method that allows the creation of complex shapes and internal structures, is a promising approach for scaffold production. However, despite the promising results obtained so far, several challenges remain in the field of TE. One critical area for improvement is tailoring the mechanical properties of scaffolds to meet specific tissue requirements. In addition, achieving improved cell viability and controlled degradation of scaffolds is necessary to ensure successful tissue regeneration. This review provides a critical summary of the potential and limitations of polymer/BG scaffold production via AM covering extrusion-, lithography-, and laser-based 3D-printing techniques. The review highlights the importance of addressing the current challenges in TE to develop effective and reliable strategies for tissue regeneration.

Repair of Osteochondral Defects in a Rabbit Model Using Bilayer Poly(Lactide-co-Glycolide) Scaffolds Loaded with Autologous Platelet-Rich Plasma

BACKGROUND To examine the effects of the addition of autologous platelet-rich plasma (PRP) into bilayer poly(lactide-co-glycolide) (PLGA) scaffolds on the reconstruction of osteochondral defects in a rabbit model. MATERIAL AND METHODS Porous PLGA scaffolds were prepared in a bilayered manner to reflect the structure of chondral and subchondral bone. Bone defects, measuring 4 mm in diameter and 4 mm in thickness, were created in both knee joints in 18 healthy New Zealand white rabbits, aged between 120-180 days old. Rabbits were randomly divided into three groups: rabbits with bone defects implanted with bilayer PLGA scaffolds (PLGA group) (N=6); or with bilayer PLGA and autologous PRP (PLGA/PRP group) (N=6); and the untreated group (control group) (N=6). The gross morphology, histology, and immunohistochemistry for the expression of collagen type II and aggrecan were observed at 12 weeks after surgery and compared using a scoring system. Micro-computed tomography (CT) imaging and relative expression of specific genes were also assessed. RESULTS The platelet concentrations in the PRP samples were found to be 4.9 times greater than that of whole blood samples. The total score on gross appearance and histology was greatest in the PLGA/PRP group, as was the expression of collagen II and aggrecan of the neo-tissue. Micro-CT imaging showed that more subchondral bone was formed in the PLGA/PRP group. CONCLUSIONS Bilayer PLGA scaffolds loaded with autologous PRP improve the reconstruction of osteochondral defects in the rabbit model.

Selective laser sintering scaffold with hierarchical architecture and gradient composition for osteochondral repair in rabbits

Osteochondral defects cannot be adequately self-repaired due to the presence of the sophisticated hierarchical structure and the lack of blood supply in cartilage. Thus, one of the major challenges remaining in this field is the structural design of a biomimetic scaffold that satisfies the specific requirements for osteochondral repair. To address this hurdle, a bio-inspired multilayer osteochondral scaffold that consisted of the poly(ε-caprolactone) (PCL) and the hydroxyapatite (HA)/PCL microspheres, was constructed via selective laser sintering (SLS) technique. The SLS-derived scaffolds exhibited an excellent biocompatibility to support cell adhesion and proliferation in vitro. The repair effect was evaluated by implanting the acellular multilayer scaffolds into osteochondral defects of a rabbit model. Our findings demonstrated that the multilayer scaffolds were able to induce articular cartilage formation by accelerating the early subchondral bone regeneration, and the newly formed tissues could well integrate with the native tissues. Consequently, the current study not only achieves osteochondral repair, but also suggests a promising strategy for the fabrication of bio-inspired multilayer scaffolds with well-designed architecture and gradient composition via SLS technique.

Comparison of tenocytes and mesenchymal stem cells seeded on biodegradable scaffolds in a full-size tendon defect model

In order to investigate cell-based tendon regeneration, a tendon rupture was simulated by utilizing a critical full-size model in female rat achilles tendons. For bridging the defect, polyglycol acid (PGA) and collagen type I scaffolds were used and fixed with a frame suture to ensure postoperatively a functional continuity. Scaffolds were seeded with mesenchymal stem cells (MSC) or tenocytes derived from male animals, while control groups were left without cells. After a healing period of 16 weeks, biomechanical, PCR, histologic, and electron microscopic analyses of the regenerates were performed. Genomic PCR for male-specific gene was used to detect transplanted cells in the regenerates. After 16 weeks, central ossification and tendon-like tissue in the superficial tendon layers were observed in all study groups. Biomechanical test showed that samples loaded with tenocytes had significantly better failure strength/cross-section ratio (P < 0.01) compared to MSC and the control groups whereas maximum failure strength was similar in all groups. Thus, we concluded that the application of tenocytes improves the outcome in this model concerning the grade of ossification and the mechanical properties in comparison to the use of MSC or just scaffold materials.

Cartilage defects of the femoral trochlea

Despite improvements in the ability to detect articular cartilage defects of the trochlea, determining the significance of these lesions remains difficult. Physical examination and history taking remain the best way to estimate the clinical impact of these lesions. Debridement and/or microfracture are often initial surgical interventions; these procedures can be expected to provide functional improvement in over 50%, but studies suggest that the amount of improvement deteriorates within 3 years. While initial reports on ACI and osteochondral allografts in the treatment of trochlear defects appear to be more promising solutions, long-term follow-up studies are lacking. Similarly, the effect of tibial tubercle osteotomy combined with cartilage restoration techniques remains unresolved. Nonetheless, based on the limited available evidence, ACI or osteochondral allografts combined with a tibial tubercle osteotomy when appropriate have provided the most durable treatment for these difficult-to-treat lesions.

Treatment of osteochondral defects of the talus

This review article provides a current concepts overview of osteochondral defects of the talus, with special emphasis on treatment options, their indications and future developments. Osteochondral defects of the talar dome are mostly caused by a traumatic event. They may lead to deep ankle pain on weight-bearing, prolonged swelling, diminished range of motion and synovitis. Plain radiographs may disclose the lesion. For further diagnostic evaluation, computed tomography (CT) and magnetic resonance imaging (MRI) have demonstrated similar accuracy. Computed tomography is preferred for preoperative planning. Treatment options are diverse and up to the present there is no consensus. Based on the current literature, we present a treatment algorithm that is mainly guided by the size of the lesion. Asymptomatic or low-symptomatic lesions are treated nonoperatively. The primary surgical treatment of defects up to 15 mm in diameter consists of arthroscopic debridement and bone marrow stimulation. For large cystic talar lesions, retrograde drilling combined with a bone graft is an important alternative. In adolescents or in (sub)acute situations, in which the fragment is 15 mm or larger, fixation of the fragment is preferred. Osteochondral autograft transfer and autologous chondrocyte implantation (ACI), with or without a cancellous bone graft, are recommended for secondary cases as well as large lesions.