Future of Orthopaedic Sports Medicine and Soft Tissue Healing: The Important Role of Engineering

Abstract

The practice of orthopaedic sports medicine, specifically the management of ligament and tendon injuries, will experience dramatic changes in the near future. Rapid technological advancements, especially in imaging, will greatly increase the speed and accuracy of diagnosing musculoskeletal injuries. On the contrary, effective treatment strategies will lag behind. This widening gap will offer huge opportunities for clinicians, basic scientists, and bioengineers to collaborate and work jointly on in depth basic science and bioengineering research. Together with appropriately designed clinical outcome studies, scientifically based treatment strategies can be designed in order to reduce the gap and to improve patient outcome. In this review, we will focus on the subject of orthopaedic biomechanics and its importance in the treatment of ligament and tendon injuries. We will detail the history of fundamental work done to characterize their biomechanical properties and highlight some recent advances using functional tissue engineering strategies, including the use of bioscaffolds, to improve the healing of medial collateral ligament, patellar tendon, and anterior cruciate ligament. To conclude, we will turn toward the future and highlight a few exciting areas of research as well as emphasize collaborative strategies to solve complex biological and biomechanical problems in ligaments and tendons.

Three-Dimensional Engineered Bone–Ligament–Bone Constructs for Anterior Cruciate Ligament Replacement

“…The sheep and goat have commonly been chosen as animal models for the knee [30][31][32][33] because of anatomical [34][35][36][37] and mechanical [38][39][40][41] similarities to human ACLs. These sheep were obtained from the Michigan Livestock Exchange, various farms in the area or intra-university transfer.…”

Characterization of the ICSI‐mediated gene transfer method in the production of transgenic pigs

“…Additionally, transgenic porcine models of human disease are expected to provide a substantial contribution to the development of new treatments and drugs (Petters et al, 1997; Rogers et al, 2008; Umeyama et al, 2009). Genetically modified pigs that act as a source of organs/tissues for xenotransplantation or tissue engineering have also been investigated (Matsunari and Nagashima, 2009; Woo et al, 2009). Furthermore, transgenic pigs that can be used as bioreactors for producing therapeutic proteins may have a significant impact on the pharmaceutical industry (Van Cott et al, 1999).…”

Allografts in Soft Tissue Reconstructive Procedures

“…Extracellular matrix bioscaffolds have been shown to promote tissue regeneration and the repair of ligaments. 5 , 6 , 49 , 80 A study by Woo et al 83 showed that utilizing a porcine small intestinal submucosa bioscaffold to heal a transected ACL following repair led to new tissue formation, significant reductions in anterior-posterior joint instability relative to ACL-deficient joints, and in situ forces of the new ACL similar in scale to those of an intact ACL.…”