Abstract
Articular cartilage damage is a primary feature of osteoarthritis and other inflammatory joint diseases (i.e., rheumatoid arthritis). Repairing articular cartilage is highly challenging due to its avascular/aneural nature and low cellularity. To induce functional neocartilage formation, the tissue substitute must have mechanical properties which can adapt well to the loading conditions of the joint. Among the various biomaterials which may function as cartilage replacements, polyvinyl alcohol (PVA) hydrogels stand out for their high biocompatibility and tunable mechanical features. This review article describes and discusses the enrichment of PVA with natural materials (i.e., collagen, hyaluronic acid, hydroxyapatite, chitosan, alginate, extracellular matrix) ± synthetic additives (i.e., polyacrylic acid, poly-lactic-co-glycolic acid, poly(ethylene glycol) diacrylate, graphene oxide, bioactive glass) to produce cartilage substitutes with enhanced mechanical performance. PVA-based hybrid scaffolds have been investigated mainly by compression, tensile, friction, stress relaxation and creep tests, demonstrating increased stiffness and friction properties, and with cartilage-like viscoelastic behavior. In vitro and in vivo biocompatibility studies revealed positive outcomes but also many gaps yet to be addressed. Thus, recommendations for future research are proposed in order to prompt further progress in the fabrication of PVA-based hybrid scaffolds which increasingly match the biological and mechanical properties of native cartilage.
Highlights
Articular cartilage (AC) is made up of native extracellular matrix which possesses distinct biochemical, biomechanical, and structural properties and is dynamically regulated by chondrocytes
We investigated, for the first time, chemical post-modification of polyvinyl alcohol (PVA) with the important aim of enhancing its biodegradation rate, since the neat polymer in the form of crosslinked hydrogel suffers from poor biodegradation capacity [41,42]
An intriguing opportunity is represented by the use of cell-free or cell-laden biomimetic scaffolds, assuring for the mechanical support and cues which can highly resemble the multiphasic nature of AC
Summary
Articular cartilage (AC) is made up of native extracellular matrix which possesses distinct biochemical, biomechanical, and structural properties and is dynamically regulated by chondrocytes. Current treatment options include total joint arthroplasty, marrow stimulating techniques, mosaicplasty, microfracture, multiple drilling, and autogenous/allogeneic chondrocyte transplantation [8,9,10]. These repair approaches still suffer from variable outcomes and important limitations which prevent satisfactory functional recovery (i.e., donor site morbidity, formation of fibrocartilage rather than hyaline cartilage, and poor integration with the host tissue) [11]. After presenting the peculiar structure and biomechanics of AC, PVA hydrogels are introduced as promising biomaterials which are already in use in the orthopedic clinical practice due to their mechanical features well resembling native. The main focus of the review is on the design of PVA-based biohybrid scaffolds and the investigation of their biomechanical/biocompatibility properties which may encourage their use in cartilage TE
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