Orthopaedic regenerative tissue engineering en route to the holy grail: disequilibrium between the demand and the supply in the operating room

Abstract

Orthopaedic disorders are very frequent, globally found and often partially unresolved despite the substantial advances in science and medicine. Their surgical intervention is multifarious and the most favourable treatment is chosen by the orthopaedic surgeon on a case-by-case basis depending on a number of factors related with the patient and the lesion. Numerous regenerative tissue engineering strategies have been developed and studied extensively in laboratory through in vitro experiments and preclinical in vivo trials with various established animal models, while a small proportion of them reached the operating room. However, based on the available literature, the current strategies have not yet achieved to fully solve the clinical problems. Thus, the gold standards, if existing, remain unchanged in the clinics, notwithstanding the known limitations and drawbacks. Herein, the involvement of regenerative tissue engineering in the clinical orthopaedics is reviewed. The current challenges are indicated and discussed in order to describe the current disequilibrium between the needs and solutions made available in the operating room. Regenerative tissue engineering is a very dynamic field that has a high growth rate and a great openness and ability to incorporate new technologies with passion to edge towards the Holy Grail that is functional tissue regeneration. Thus, the future of clinical solutions making use of regenerative tissue engineering principles for the management of orthopaedic disorders is firmly supported by the clinical need.

The Role of Collagen Scaffold and Stromal Vascular Fraction on Healing Process in Growth Plate Injury (SOX9 and Histological Examination)

“…Therefore, if it can prevent its formation, it can also prevent complications which may arise in growth plate injury. This research can prove that tissue engineering can inhibit the formation of a bony bridge in growth plate injury [6].…”

Meniscal allograft transplants and new scaffolding techniques

“…8), biological enhancement of surgical approaches (cells, growth factors, proteins, nanotechnology, hydrogels), amongst many other advanced approaches aiming to fix, replace or improve any biological system. 44,45,62,110,111…”

“…60,61 Tissue engineering technologies raise the possibilities, in future, of providing a limitless source of effective tissue for meniscus replacement (partial or total), avoiding the previously described limitations and concerns of allografts related to donors, with the associated complicated processing and size-matching issues. 27,62…”

Preclinical safety study of a combined therapeutic bone wound dressing for osteoarticular regeneration

“…Besides their variable outcome 8 and intrinsic limitations 9,10 none of the afore-mentioned techniques was shown to restore the hyaline articular surface 11 , justifying the search for alternatives to promote osteoarticular regeneration (OAR). Recently, autologous chondrocytes pre-cultured on a membrane of mammalian collagen 12–15 , were used to fill articular focal lesions and promote cartilage regeneration. However, when performed on subchondral bone, they showed site morbidity and fibrocartilage formation 16 , leading to a dysfunctional repair.…”