A new resorbable bone void filler in trauma: early clinical experience and histologic evaluation

3D printed PCL/β-TCP cross-scale scaffold with high-precision fiber for providing cell growth and forming bones in the pores

Scaffolds prepared by 3D printing are increasingly used in the field of bone tissue repair. However, on traditional 3D printed bone tissue engineering scaffolds, cells can only grow on the fiber surface and form bone. We designed a scaffold with a cross-scale structure of PCL/β-TCP, which contains thick fibers with a diameter of 500 μm printed by FDM. And in the pores of the coarse fiber, the ultra-high precision fine fiber grid with a diameter of about 10 μm is filled by MEW mode. In cell experiments, cells can not only grow on the thick fiber surface of the cross-scale scaffold. At the same time, the mesh structure of fine fibers provides a bridge for cell growth, allowing cells to pass through the pores of thick fibers and grow in the pores and gradually cover the pores of the scaffold. In the osteoinduction experiment, β-TCP in the PCL/β-TCP composite provides Ca²⁺ and PO₄^3- to the scaffold, which effectively promotes the osteogenic differentiation of cells on the scaffold. Compared with traditional scaffolds, the osteogenic performance of cross-scale scaffolds is greatly improved. Not only did bone form on the surface of the scaffold, but also obvious ALP expression and effective calcium precipitation appeared in the pores of the scaffold. This can effectively speed up the repair of bone defects. We believe that the 3D printed PCL/β-TCP cross-scale scaffold with high-precision fibers has great application prospects in the field of bone tissue engineering.

Calcium Concentration in Culture Medium as a Nondestructive and Rapid Marker of Osteogenesis

Artificial bones made of β-tricalcium phosphate (β-TCP) combined with bone marrow-derived mesenchymal stromal cells (BM-MSCs) are used for effective reconstruction of bone defects caused by genetic defects, traumatic injury, or surgical resection of bone tumors. However, the selection of constructs with high osteogenic potential before implantation is challenging. The purpose of this study was to determine whether the calcium concentration in BM-MSC culture medium can be used as a nondestructive and simple osteogenic marker for selecting tissue-engineered grafts constructed using β-TCP and BM-MSCs. We prepared three cell passages of BM-MSCs derived from three 7-week-old, male Fischer 344 rats; the cells were cultured in osteoinductive medium in the presence of β-TCP for 15 days. The medium was replaced with fresh medium on day 1 in culture and subsequently changed every 48 h; it was collected for measurement of osteocalcin secretion and calcium concentration by enzyme-linked immunosorbent assay and X-ray fluorescence spectrometry, respectively. After cultivation, the constructs were implanted subcutaneously into the backs of recipient rats. Four weeks after implantation, the alkaline phosphatase (ALP) activity and osteocalcin content of the constructs were measured. A strong inverse correlation was observed between the calcium concentration in the medium and the ALP activity and osteocalcin content of the constructs, with Pearson's correlation coefficients of 0.92 and 0.90, respectively. These results indicate that tissue-engineered bone with high osteogenic ability can be selected before implantation based on low calcium content of the culture medium, resulting in successful bone formation after implantation. This nondestructive, simple method shows great promise for assessing the osteogenic ability of tissue-engineered bone.

The effects of microporosity on osteoinduction of calcium phosphate bone graft substitute biomaterials

The effect of increasing strut porosity on the osteoinductive ability of silicate substituted calcium phosphate (SiCaP) biomaterials was investigated in an ectopic ovine model. Implants with strut porosities of 22.5%, 32.0% and 46.0% were inserted into the parapsinalis muscle. At 8, 12 and 24 weeks histological sections were prepared. Sections were examined using backscattered scanning electron microscopy and un-decalcified histology. Bone area, implant area and bone-implant contact were quantified. At 8 weeks there was no significant difference between the groups in terms of bone area and implant area. However at 12 weeks, the amount of bone formation observed was significantly greater in SiCaP-46 (6.17 ± 1.51%) when compared with SiCaP-22.5 (1.33 ± 0.84%) p=0.035. Results also showed significantly increased amounts of bone-implant contact to the SiCaP-46 scaffold (3.30 ± 1.17%) compared with SiCaP-22.5 (0.67 ± 0.52%, p=0.043) at 8 weeks and 12 weeks; (SiCaP-46 (21.82 ± 5.59%) vs SiCaP-22.5 (3.06 ± 1.89%), p=0.012). At 24 weeks, bone formation and graft resorption had significantly increased in all groups so that the level of bone formation in the SiCaP-46 group had increased 75-fold to 30.05 ± 8.38%. Bone formation was observed in pores <10 μm. Results suggest that bone graft substitute materials with greater strut porosity are more osteoinductive.

Autologous bone marrow derived mononuclear cells combined with β-tricalcium phosphate and absorbable atelocollagen for a treatment of aneurysmal bone cyst of the humerus in child

Aneurysmal bone cyst is a benign, locally destructive lesion of bone. Based on progressive cortical thinning pathological fractures are common, and are often the presenting feature. Despite the long experience of orthopaedists, radiologists and pathologists with aneurysmal bone cyst there is limited knowledge regarding the cause of the lesion and optimal treatment. Common methods of treatment vary considerably in the literature, particularly in children. A large variety of bone substitutes have been used to fill the cystic lesions. To date there has been no graft material which can be regarded as completely satisfactory. Our experience with freshly isolated autologous bone marrow derived mononuclear cells combined with β-tricalcium phosphate and absorbable atelocollagen for bone formation is presented. The concept of this treatment is based on stimulation of natural events continuously present in living bone appear to be a reasonable and beneficial alternative to promote healing of bone cysts and offering both osteoinduction and osteoconductive features.

Bone substitutes in the Netherlands - a systematic literature review

Autologous bone grafting is currently considered as the gold standard to restore bone defects. However, clinical benefit is not guaranteed and there is an associated 8-39% complication rate. This has resulted in the development of alternative (synthetic) bone substitutes. The aim of this systematic literature review was to provide a comprehensive overview of literature data of bone substitutes registered in the Netherlands for use in trauma and orthopedic surgery. Brand names of selected products were used as search terms in three available databases: Embase, PubMed and Cochrane. Manuscripts written in English, German or Dutch that reported on structural, biological or biomechanical properties of the pure product or on its use in trauma and orthopedic surgery were included. The primary search resulted in 475 manuscripts from PubMed, 653 from Embase and 10 from Cochrane. Of these, 218 met the final inclusion criteria. Of each product, structural, biological and biomechanical characteristics as well as their clinical indications in trauma and orthopedic surgery are provided. All included products possess osteoconductive properties but differ in resorption time and biomechanical properties. They have been used for a wide range of clinical applications; however, the overall level of clinical evidence is low. The requirements of an optimal bone substitute are related to the size and location of the defect. Calcium phosphate grafts have been used for most trauma and orthopedic surgery procedures. Calcium sulphates were mainly used to restore bone defects after tumour resection surgery but offer minimal structural support. Bioactive glass remains a potential alternative; however, its use has only been studied to a limited extent.

Resorbable glass-ceramic phosphate-based scaffolds for bone tissue engineering: synthesis, properties, and in vitro effects on human marrow stromal cells

Highly porous bioresorbable glass-ceramic scaffolds were prepared via sponge replication method by using an open-cell polyurethane foam as a template and phosphate-based glass powders. The glass, belonging to the P2O5-SiO2-CaO-MgO-Na2O-K2O system, was synthesized by a melting-quenching route, ground, and sieved to obtain powders with a grain size of less than 30 μm. A slurry containing glass powders, polyvinyl alcohol, and water was prepared to coat the polymeric template. The removal of the polymer and the sintering of the glass powders were performed by a thermal treatment, in order to obtain an inorganic replica of the template structure. The structure and properties of the scaffold were investigated from structural, morphological, and mechanical viewpoints by means of X-ray diffraction, scanning electron microscopy, density measurements, image analysis, and compressive tests. The scaffolds exhibited a trabecular architecture that closely mimics the structure of a natural spongy bone. The solubility of the porous structures was assessed by soaking the samples in acellular simulated body fluid (SBF) and Tris-HCl for different time frames and then by assessing the scaffold weight loss. As far as the test in SBF is concerned, the nucleation of hydroxyapatite on the scaffold trabeculae demonstrates the bioactivity of the material. Biological tests were carried out using human bone marrow stromal cells to test the osteoconductivity of the material. The cells adhered to the scaffold struts and were metabolically active; it was found that cell differentiation over proliferation occurred. Therefore, the produced scaffolds, being biocompatible, bioactive, resorbable, and structurally similar to a spongy bone, can be proposed as interesting candidates for bone grafting.

Electron microscopic study on bone formation and bioresorption after implantation of beta-tricalcium phosphate in rabbit models

BACKGROUND

The role of bone formation and bioresorption in an early stage after implantation of beta-tricalcium phosphate (beta-TCP) was investigated using scanning and transmission electron microscopy (SEM, TEM).

METHODS

The ceramic beta-TCP cylinders were implanted into cavities drilled in the femoral condyles of eight NZW rabbits. Four of the rabbits were sacrificed at 2 weeks and four at 4 weeks after implantation, respectively. The femoral condyles were excised to prepare the specimens for SEM and TEM.

RESULTS

SEM showed giant cells of more than 20 mum in diameter were observed on the surface of beta-TCP at 2 weeks after implantation. TEM demonstrated that collagen fibrils secreted from the monocytic cells invaded beta-TCP micropores at 2 weeks. Multinucleated giant cells (MNGCs) were in contact with the surface of beta-TCP at 2 weeks. Some of them had a ruffled border (RB) at the cell-substrate interface, characteristic of osteoclasts.

CONCLUSIONS

These findings suggest that cell-mediated disintegration by osteoclasts played a role in the bioresorption of beta-TCP at an early stage after implantation. In addition, the micropores of beta-TCP ceramic may provide an environment for collagen formation, leading to the deposition of apatite crystals. Therefore, the micropores facilitate bone ingrowth as well as ceramic resorption.

Human Shaped Thumb Bone Tissue Engineered by Hydrogel-β-Tricalciumphosphate/Poly-ε-Caprolactone Scaffolds and Magnetically Sorted Stem Cells

Traumatic amputation of a thumb with bone loss leaves a patient in severe disability. Reconstructive procedures are restricted by limited shape and have the disadvantage of severe donor-site morbidity. To overcome these limitations, we used a tissue engineering approach to create a distal thumb bone phalanx, combining magnetically sorted 133+ human mesenchymal stem cells (hMSCs) suspended in successful tested hydrogels for bone formation and porous 3-dimensionally printed scaffolds (3DP) in the shape of a distal thumb bone phalanx. Collagen I and fibrin glue hydrogels with suspended hMSCs were first histologically evaluated in vitro for bone formation after 6 weeks. Then 3DP scaffolds, made from a mix of osteoinductive and -conductive beta-tricalciumphosphate (beta-TCP) and poly-epsilon-caprolactone (PCL), with hydrogels and suspended hMSCs, were implanted into nude mice subcutaneously for 15 weeks. Histologic evaluation, high-resolution volumetric CT (VCT) scanning, and biomechanical testing confirmed formation of bonelike tissue. Both hydrogels with CD 133+ hMSCs on 3DP scaffolds supported bone formation. Collagen I resulted in radiologically better bone formation. Bone tissue can be successfully tissue engineered with CD 133+ hMSCs, collagen I hydrogels, and porous 3DP beta-TCP/PCL scaffolds.

Comparison of Hydrogels in theIn VivoFormation of Tissue-Engineered Bone Using Mesenchymal Stem Cells and Beta-Tricalcium Phosphate

Availability of grafts and morbidity at the donor site limit autologous transplantation in patients requiring bone reconstruction. A tissue-engineering approach can overcome these limitations by producing bone-like tissue of custom shape and size from isolated cells. Several hydrogels facilitate osteogenesis on porous scaffolds; however, the relative suitability of various hydrogels has not been rigorously assessed. Fibrin glue, alginate, and collagen I hydrogels were mixed with swine bone marrow-derived differentiated mesenchymal stem cells (MSCs), applied to 3-dimensionally printed porous beta-tricalcium phosphate (beta-TCP) scaffolds and implanted subcutaneously in nude mice. Although noninvasive assessment of osteogenesis in 3 dimensions is desirable for monitoring new bone formation in vivo, correlations with traditional histological and mechanical testing need to be established. High-resolution volumetric computed tomography (VCT) scanning, histological examination, biomechanical compression testing, and osteonectin (ON) expression were performed on excised scaffolds after 1, 2, 4, and 6 weeks of subcutaneous implantation in mice. Statistical correlation analyses were performed between radiological density, stiffness, and ON expression. Use of collagen I as a hydrogel carrier produced superior bone formation at 6 weeks, as demonstrated using VCT scanning with densities similar to native bone and the highest compression values. Continued contribution of the seeded MSCs was demonstrated using swine-specific messenger ribonucleic acid probes. Radiological density values correlated closely with the results of histological and biomechanical testing and ON expression. High-resolution VCT is a promising method for monitoring osteogenesis.

Release of gentamicin from a tricalcium phosphate bone implant

The impregnation and elution of gentamicin antibiotic from a commercially available porous beta-tricalcium phosphate (TCP) bone implant material (Vitoss, Orthovita, Inc.) was investigated in vitro. Sustained local antibiotic release is an attractive method for the prevention of infection following surgery. The purpose of this study was to evaluate the use of the naturally forming clot that occurs within a porous tissue scaffold when combined with autologous blood or bone marrow aspirate (BMA) as a method for achieving controlled drug delivery. The diffusion of antibiotic from porous TCP scaffolds was studied using water, clotted blood, or BMA as impregnating fluids. Incorporation of the drug into the porous scaffold using clotted blood or BMA as a binder produced slowed release relative to aqueous impregnated and dried samples. Modifications were made to the elution method to simulate restricted diffusion due to surrounding clotted blood, tissue, or bone that would occur in vivo. These modified methods simulated release in a surgical site and showed long release profiles, with significant amounts of antibiotic being released for up to 2 weeks. We concluded that adding gentamicin with autologous BMA is a promising method of controlling drug release.

The use of nanocrystalline hydroxyapatite for the reconstruction of calcaneal fractures: Preliminary results

The purpose of this investigation was to evaluate the feasibility of a nanocrystalline hydroxyapatite compound in the treatment of calcaneal fractures with osseous defects after reduction. The study included 21 patients, representing 24 closed intraarticular calcaneus fractures with large defects remaining after operative reduction. All cases were supplemented with the hydroxyapatite bone substitute and stabilized with a calcaneal honeycomb plate. Radiographs were taken at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively, with specific attention given to measurement of Gissane's angle, Böhler's angle, and calcaneal height. A postoperative subjective and objective evaluation of the fracture, using the Creighton Nebraska Health Foundation scale, was performed 1 year postoperatively. Böhler's angle improved from a mean 8.6 +/- 5.3 degrees preoperatively to an immediate postoperative mean result of 31.5 +/- 6.5 degrees and 27.7 +/- 8.6 1 year postoperatively. The mean Creighton-Nebraska functional score was 86 +/- 10 at the 1-year follow-up evaluation. These results suggest that open reduction with plate fixation combined with nanocrystalline hydroxyapatite augmentation presents a good and reliable surgical technique for treatment of calcaneus fractures.

Grafting of massive tibial subchondral bone defects in a caprine model using beta-tricalcium phosphate versus autograft

OBJECTIVE

This study evaluated the ability of beta-tricalcium phosphate particles (beta-TCP) and autograft (AUTO) to maintain joint surface morphology when used to supplement massive subchondral bone defects in a caprine model.

DESIGN

This was a prospective, parallel arm study with 2 experimental arms and a control group.

METHODS

Unilateral, 11 mm diameter, 25 mm deep cylindrical defects were created in tibial subchondral bone of anesthetized goats (n = 16) and filled with autograft or beta-tricalcium phosphate particles. The contralateral limbs served as internal controls. Goats were killed at 3 months and both tibiae harvested. Molds made of the tibial plateau surface were used to create positive casts from which medial and lateral tibial plateau surfaces of both experimental (beta-tricalcium phosphate particles, autograft) and control limbs were digitized in 3 dimensions. Mirror images of the medial condyle surface contours from the controls were superimposed onto the experimental surfaces and deviations were compared using a Student t test (alpha = 0.05). Tibiae were then cut sagittally into medial (biomechanics) and lateral (histology) halves. Compressive modulus within the defect area was assessed by indentation to 2.0 mm at 0.2 mm per second using a 6-mm diameter pin. Specimens from the lateral tibial plateau were processed for undecalcified histology and the area of bone within the defect region measured. The articular surface of 86% of the autograft and 0% of the beta-tricalcium phosphate particles group had degenerative changes, with 29% of autograft goats exhibiting large-scale plateau collapse. Mean surface deviation for autograft was significantly greater than for beta-tricalcium phosphate particles (2.19 +/- 1.49 mm versus 0.78 +/- 0.19 mm), as was maximum surface deviation (11.19 +/- 8.02 mm versus 4.39 +/- 1.33 mm) (P < 0.05). The compressive modulus within the defect area for control animals was significantly higher than the experimental groups (P < 0.05). Significantly more bone was regenerated within beta-tricalcium phosphate particle-grafted defects compared to autograft (P < 0.05). These results indicated that beta-tricalcium phosphate particles might be a useful graft material for local repair of load bearing skeletal sites such as depressed tibial plateau fractures.