Professor Stanford University Stanford, California, United States
Introduction:: Musculoskeletal disorders (MSK) impose a substantial economic burden on national healthcare systems, costing more than US$950 billion annually in the USA. These conditions greatly impact mobility and significantly reduce the quality of life for patients, particularly the elderly. Regenerative medicine and tissue engineering offer promising solutions to improve the treatment of musculoskeletal ailments and restore lost functions. In this presentation, I will discuss our advancements in implantable devices using the Hybrid Tissue Engineering Construct (HyTEC) strategy for large orthopedic trauma regeneration and the Functionally Graded Biomaterial (FGB) strategy for repairing rotator cuff injuries.
Materials and Methods:: For both studies of large bone defect repair and rotator cuff injuries, the clinically relevant rodent disease models were first established, and the novel bioactive biodegradable implantable device were developed and characterized in vitro. The effects of the novel bioactive biodegradable implantable devices on bone and tendon repairs were then investigated in the rodent models. Furthermore, the preclinical sheep models were used to test the clinical feasibility of the implantable devices.
Results, Conclusions, and Discussions:: Limb salvage techniques such as fracture stabilization or reconstruction have been applied to manage large bone defects for decades. In particular, the Ilizarov technique, based on the principles of distraction osteogenesis, represents a well-established limb salvage procedure for managing large bone defects. However, it also has several disadvantages, including pin tract infection, docking site nonunion, and poor bone regeneration, which may prolong the treatment duration. Among these, docking site nonunion is frequently encountered due to inactive bone contact and soft tissue intrusion at the docking site which can lead to pseudarthrosis. To achieve bone bridging at the docking site, secondary debridement and bone grafting surgery are often necessary, causing additional pain, morbidity, hospitalizations, and economic burden for patients. In addition, more than 650,000 rotator cuff procedures are performed annually in US with a growing rate of 5-6% per annum. They suffer from the re-tears after surgical treatment. The findings of our studies in HyTEC and FGB strategies demonstrate that the novel bioactive biodegradable implantable devices hold great promise for advancing orthopedic repair and regeneration by promoting tissue regeneration and reducing complications in the treatment of bone and tendon defects.