Abstract

The current gold standard technique for treatment of anterior cruciate ligament (ACL) injury is reconstruction with autograft. These treatments have a relatively high failure and re-tear rate. To overcome this, tissue engineering and additive manufacturing are being used to explore the potential of 3D scaffolds as autograft substitutes. However, mechanically optimal polymers for this have yet to be identified. Here, we use 3D printing technology and various materials with the aim of fabricating constructs better matching the mechanical properties of the native ACL. A fused deposition modeling (FDM) 3D printer was used to microfabricate dog bone-shaped specimens from six different polymers—PLA, PETG, Lay FOMM 60, NinjaFlex, NinjaFlex-SemiFlex, and FlexiFil—at three different raster angles. The tensile mechanical properties of these polymers were determined from stress–strain curves. Our results indicate that no single material came close enough to successfully match reported mechanical properties of the native ACL. However, PLA and PETG had similar ultimate tensile strengths. Lay FOMM 60 displayed a percentage strain at failure similar to reported values for native ACL. Furthermore, raster angle had a significant impact on some mechanical properties for all of the materials except for FlexiFil. We therefore conclude that while none of these materials alone is optimal for mimicking ACL mechanical properties, there may be potential for creating a 3D-printed composite constructs to match ACL mechanical properties. Further investigations involving co-printing of stiff and elastomeric materials must be explored.

Highlights

  • The anterior cruciate ligament (ACL) is one of the most frequently injured structures during sporting or high impact activities [1]

  • This study aims to fill this gap by testing different polymers, and three differing raster angles to identify optimal combinations to match the mechanical strength of the ACL

  • polyethylene terephthalate glycol (PETG) and polylactic acid (PLA) showed traditional deformation profiles, while the other materials showed more elastomeric behavior. They were split into two groups for analysis: stiff (PLA and PETG) or flexible (Lay FOMM, SemiFlex, NinjaFlex and FlexiFil)

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Summary

Introduction

The anterior cruciate ligament (ACL) is one of the most frequently injured structures during sporting or high impact activities [1]. It is one of two cruciate ligaments in the knee and ensures passive restraint of anterior translation and rotation of the tibia with respect to the femur, in part due to its anisotropic properties [2,3,4]. ACL injuries can result in reduced functional performance but are associated with long-term clinical conditions that include meniscal tears, cartilage lesions and an increased risk of early onset post-traumatic osteoarthritis (OA) [17]. It was found that one in nine patients who undergo ACL reconstruction will have a re-rupture or clinical failure at long-term follow up

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