Kivanc Atesok1, M Nedim Doral2, Jon Karlsson3, Kenneth A Egol4, Laith M Jazrawi5, Paulo G Coelho6, Amaury Martinez5, Tomoyuki Matsumoto7, Brett D Owens8, Mitsuo Ochi9, Shepard R Hurwitz10,11, Anthony Atala12, Freddie H Fu13, Helen H Lu14, Scott A Rodeo15. 1. Sports Medicine and Shoulder Service, Hospital for Special Surgery, 525 East 71st Street, New York, NY, 10021, USA. 2. Department of Orthopaedics and Traumatology, Hacettepe University School of Medicine, 06100, Sihhiye, Ankara, Turkey. 3. Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, 431 80, Molndal, Sweden. 4. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 303 2nd Avenue, New York, NY, 10003, USA. 5. Center for Musculoskeletal Care, NYU Hospital for Joint Diseases, 333 east 38th street, New York, NY, 10016, USA. 6. Department of Periodontology and Implant Dentistry, New York University College of Dentistry, 345 east 24th street Room 804s, New York, NY, 10010, USA. 7. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan. 8. Orthopaedic Surgery Service, Keller Army Hospital, 900 Washington Rd, West Point, New York, NY, 10996, USA. 9. Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamimi-ku, Hiroshima, 734-8551, Japan. 10. Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA. 11. American Board of Orthopaedic Surgery, 400 Silver Cedar Court, Chapel Hill, NC, 27514, USA. 12. Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA. 13. Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA. 14. Department of Biomedical Engineering, Columbia University, New York, NY, 10016, USA. 15. Sports Medicine and Shoulder Service, Hospital for Special Surgery, 525 East 71st Street, New York, NY, 10021, USA. RodeoS@HSS.edu.
Abstract
PURPOSE: The purpose of this study was to summarize the recent developments in the field of tissue engineering as they relate to multilayer scaffold designs in musculoskeletal regeneration. METHODS: Clinical and basic research studies that highlight the current knowledge and potential future applications of the multilayer scaffolds in orthopaedic tissue engineering were evaluated and the best evidence collected. Studies were divided into three main categories based on tissue types and interfaces for which multilayer scaffolds were used to regenerate: bone, osteochondral junction and tendon-to-bone interfaces. RESULTS: In vitro and in vivo studies indicate that the use of stratified scaffolds composed of multiple layers with distinct compositions for regeneration of distinct tissue types within the same scaffold and anatomic location is feasible. This emerging tissue engineering approach has potential applications in regeneration of bone defects, osteochondral lesions and tendon-to-bone interfaces with successful basic research findings that encourage clinical applications. CONCLUSIONS: Present data supporting the advantages of the use of multilayer scaffolds as an emerging strategy in musculoskeletal tissue engineering are promising, however, still limited. Positive impacts of the use of next generation scaffolds in orthopaedic tissue engineering can be expected in terms of decreasing the invasiveness of current grafting techniques used for reconstruction of bone and osteochondral defects, and tendon-to-bone interfaces in near future.
PURPOSE: The purpose of this study was to summarize the recent developments in the field of tissue engineering as they relate to multilayer scaffold designs in musculoskeletal regeneration. METHODS: Clinical and basic research studies that highlight the current knowledge and potential future applications of the multilayer scaffolds in orthopaedic tissue engineering were evaluated and the best evidence collected. Studies were divided into three main categories based on tissue types and interfaces for which multilayer scaffolds were used to regenerate: bone, osteochondral junction and tendon-to-bone interfaces. RESULTS: In vitro and in vivo studies indicate that the use of stratified scaffolds composed of multiple layers with distinct compositions for regeneration of distinct tissue types within the same scaffold and anatomic location is feasible. This emerging tissue engineering approach has potential applications in regeneration of bone defects, osteochondral lesions and tendon-to-bone interfaces with successful basic research findings that encourage clinical applications. CONCLUSIONS: Present data supporting the advantages of the use of multilayer scaffolds as an emerging strategy in musculoskeletal tissue engineering are promising, however, still limited. Positive impacts of the use of next generation scaffolds in orthopaedic tissue engineering can be expected in terms of decreasing the invasiveness of current grafting techniques used for reconstruction of bone and osteochondral defects, and tendon-to-bone interfaces in near future.
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