Abstract
The aims of this paper are: (1) to review the current state of the art in the field of cartilage substitution and regeneration; (2) to examine the patented biomaterials being used in preclinical and clinical stages; (3) to explore the potential of polymeric hydrogels for these applications and the reasons that hinder their clinical success. The studies about hydrogels used as potential biomaterials selected for this review are divided into the two major trends in tissue engineering: (1) the use of cell-free biomaterials; and (2) the use of cell seeded biomaterials. Preparation techniques and resulting hydrogel properties are also reviewed. More recent proposals, based on the combination of different polymers and the hybridization process to improve the properties of these materials, are also reviewed. The combination of elements such as scaffolds (cellular solids), matrices (hydrogel-based), growth factors and mechanical stimuli is needed to optimize properties of the required materials in order to facilitate tissue formation, cartilage regeneration and final clinical application. Polymer combinations and hybrids are the most promising materials for this application. Hybrid scaffolds may maximize cell growth and local tissue integration by forming cartilage-like tissue with biomimetic features.
Highlights
Current Clinical Approaches and the Need for New DevelopmentsThe aim of this paper is to review the current state of the art of materials for cartilage substitution and regeneration
When trying to compare different studies of novel materials once they are introduced into clinical practice, there are other problems: (1) lack of homogeneity due to the different studied population; (2) short- and mid-follow-ups; (3) use of different evaluation systems; (4) new scaffold-based strategies for cartilage regeneration, either cell seeded or cell-free biomaterials; (5) procedures which differ in scaffold fixation methods, surgical approaches and postoperative rehabilitation phases
II Scaffolds and glycosaminoglycans (GAGs) are cartilage-specific extracellular matrix components; they play a crucial role in regulating the expression of chondrocytic phenotype and in Investigations based on cell-free hydrogel scaffolds focus on their physico-chemical supporting chondrogenesis
Summary
The aim of this paper is to review the current state of the art of materials for cartilage substitution and regeneration. 10 years, focusing on preparation and characterization, natural and synthetic polymer precursors, gelation kinetics, cell and drug delivery, growth factors, mechanical properties and biocompatibility Most of those reviews do not propose new alternatives to improve hydrogels properties which can fulfill the real clinical needs in terms of tissue regeneration, mechanical properties and degradation kinetics. Scaffolds based on tissue-engineered constructs, osteochondral biomimetic scaffolds, cell-free biphasic or three-phasic scaffolds, autologous scaffolds, engineered-tissue grafts, porous implants have not demonstrated to be a satisfactory solution in clinical application. When trying to compare different studies of novel materials once they are introduced into clinical practice, there are other problems: (1) lack of homogeneity due to the different studied population; (2) short- and mid-follow-ups; (3) use of different evaluation systems; (4) new scaffold-based strategies for cartilage regeneration, either cell seeded or cell-free biomaterials; (5) procedures which differ in scaffold fixation methods, surgical approaches and postoperative rehabilitation phases. There is the need among scientists, clinicians, industry and regulatory experts to improve communication and collaboration in order to overcome all the barriers in tissue engineering and to establish a defined road map to reach clinical application
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