Scaffolds play an important role in directing three-dimensional (3D) cartilage regeneration. Our recent study reported the potential advantages of bone marrow clots (MC) in promoting extracellular matrix (ECM) scaffold chondrogenic regeneration. The aim of this study is to build a new scaffold for MC, with improved characteristics in mechanics, shaping, and biodegradability, compared to our previous study. To address this issue, this study prepared a 3D porous polycaprolactone (PCL)-hydroxyapatite (HA) scaffold combined with MC (Group A), while the control group (Group B) utilized a bone marrow stem cell seeded PCL-HA scaffold. The results of in vitro cultures and in vivo implantation demonstrated that although an initial obstruction of nutrient exchange caused by large amounts of fibrin and erythrocytes led to a decrease in the ratio of live cells in Group A, these scaffolds also showed significant improvements in cell adhesion, proliferation, and chondrogenic differentiation with porous recanalization in the later culture, compared to Group B. After 4 weeks of in vivo implantation, Group A scaffolds have a superior performance in DNA content, Sox9 and RunX2 expression, cartilage lacuna-like cell and ECM accumulation, when compared to Group B. Furthermore, Group A scaffold size and mechanics were stable during in vitro and in vivo experiments, unlike the scaffolds in our previous study. Our results suggest that the combination with MC proved to be a highly efficient, reliable, and simple new method that improves the biological performance of 3D PCL-HA scaffold. The MC-PCL-HA scaffold is a candidate for future cartilage regeneration studies.Introduction D ue to the poor regenerative capacity of cartilage in vivo, articular cartilage defect is a great challenge in the field of orthopedic surgery.1 There are several cartilage repair techniques, including microfracture, joint irrigation or debridement, osteochondral grafting, and autologous chondrocyte implantation.2,3 As it is a simple, convenient, and relatively inexpensive choice, microfracture has become the preferred clinical treatment. 4 Previous evidence proved that bone marrow clots (MC) on the surface of the microfracture lesions provide an optimal environment for cartilaginous tissue repair. 5,6 However, this technique results in a repaired tissue with lower mechanical strength. This tissue is easily worn by daily activities, causing symptoms to recur and necessitating a second repair. 7,8 The poor mechanical strength, the instability of MC, and the loss of bone marrowderived mesenchymal stem cell (BMSCs) may be the main barriers to fibrocartilage repair by microfracture. 9 Although the detailed mechanisms by which MC fibrocartilage forms are not clear, the combination of MC chondrogenic differentiation and high-strength biodegradable scaffolds may provide an advanced approach to the repair and functional reconstruction of cartilage defects.
10,11The fundamental concept underlying tissue engineering is the combination of a scaffold with living cells and/o...