An Overview of Scaffold Design and Fabrication Technology for Engineered Knee Meniscus

Abstract

Current surgical treatments for meniscal tears suffer from subsequent degeneration of knee joints, limited donor organs and inconsistent post-treatment results. Three clinical scaffolds (Menaflex CMI, Actifit ® scaffold and NUsurface ® Meniscus Implant) are available on the market, but additional data are needed to properly evaluate their safety and effectiveness. Thus, many scaffold-based research activities have been done to develop new materials, structures and fabrication technologies to mimic native meniscus for cell attachment and subsequent tissue development, and restore functionalities of injured meniscus for long-term effects. This study begins with a synopsis of relevant structural features of meniscus and goes on to describe the critical considerations. Promising advances made in the field of meniscal scaffolding technology, in terms of biocompatible materials, fabrication methods, structure design and their impact on mechanical and biological properties are discussed in detail. Among all the scaffolding technologies, additive manufacturing (AM) is very promising because of its ability to precisely control fiber diameter, orientation, and pore network micro-architecture to mimic the native meniscus microenvironment.

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“…[46][47][48] The interest of this approach in orthopedics is tremendous: eg, meniscus replacement, affecting millions of people around the world. [49][50][51] All these applications demonstrate how PCL is a key player in tissue engineering, providing therapeutic benefits particularly thanks to the new 3Dprinting technology; these multiple applications of various devices contribute to evidence PCL safety.…”

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“…It is also interesting that only 7% of survey interviewees felt that more than 50% of production would take place using AM technologies in 2030. In total, 94% believe that this situation will not arise or will occur only on an occasional basis, strengthening the idea that AM will end up being integrated into the current manufacturing systems without disruption (except perhaps in highly localized niches such as medicine where new and very advantageous opportunities arise with the personalization of prostheses and organs, for example [ 53 , 54 ]). The panorama set out is perfectly compatible with the manufacture of very short runs or single items, perhaps customized for the user.…”

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“…Despite encouraging results, these procedures still show shortcomings: donor site morbidity and graft failure due to peripheral chondrocyte death in the case of osteochondral grafting; implant availability and biomechanical integrity, short cell viability, and risk of disease transmission for allografts; cell leaking in the articular space and loss of chondrogenic phenotype in case of the ACI first-generation technique utilizing expanded chondrocytes; and the need for two interventions, delaying times and increasing costs for scaffold-based ACI [ 2 ]. As for meniscus, tissue tears can be treated with either non-operative treatments [ 6 , 7 ] or by surgical procedures such as partial or total meniscectomy. However, both interventions have been demonstrated to expose femoral condyles and tibial plateau to excessive wear, thus highly predisposing to OA [ 8 ].…”