In Situ 3D Bioprinting of Musculoskeletal Tissues in Orthopedic Surgery

Abstract

Annually, millions of Americans require some form of reconstructive surgery as the result of a traumatic injury, degenerative process or pathologic state. In the field of orthopedic surgery, the gold standard for augmenting bone, cartilage and soft tissue defects has been through the application of grafts, prostheses and soft-tissue flaps. Recently, there have been great advances within the field of tissue engineering including the development of 3D-bioprinting technology. Bioprinting uses biomaterials and cells to create 3D tissue-mimicking structures aimed at repairing or replacing damaged tissues. Further developments have led to in situ bioprinting which manufactures the tissue directly at the site of repair through handheld or portable 3D-bioprinting devices. Challenges still exist in implementing this technology. However, there is hope that one day this technology will be equipped for the operating room or clinic.

Intraoperative Creation of Tissue-Engineered Grafts with Minimally Manipulated Cells: New Concept of Bone Tissue Engineering In Situ

“…Several successful attempts have been made to adapt various bioprinting technologies for intraoperative tissue engineering [ 98 , 99 ]. Laser-assisted bioprinting with photoactivated gel could become a reliable tool in orthopedic surgery in the future for osteochondral repairing and cartilage engineering in situ [ 100 , 101 ]. However, existing examples of its application for bone engineering in situ are extremely rare.…”

Organ bioprinting: progress, challenges and outlook

“…164 In situ bioprinting has been significantly improved by the occurrence of handheld bioprinting devices, which consist of a portable bioprinting device that supports controllable bioink deposition via a direct-writing method, while the operator moves and positions the device manually. Different handheld device designs have been described for in situ bioprinting of bone, 165,166 cartilage, 167,168 dental pulp, 169 skin, 170,171 and muscle. 172,173 In addition, in situ bioprinting has also been carried out using typical bioprinting setups with automatic moving platforms for repairs of the skull [174][175][176] and skin.…”

In vivo bioprinting: Broadening the therapeutic horizon for tissue injuries

“…Several handheld in situ bioprinting devices have been reported and implemented for the treatment of tissue injuries, including bone [ 128 , 129 ], cartilage [ 25 , 40 ], dental pulp [ 125 ], skin [ 41 , 130 ], and muscle [ 42 , 43 , 131 ]. Among them, the ongoing and long-term studies include the “Biopen” proposed by Bella's group [ 25 , [38] , [39] , [40] ], which spent five years progressing from prototype development and exploration of printing parameters to coaxialization improvements of the printhead and evaluation of biological metrics ( Fig.…”