Biomedical Engineering Reference
In-Depth Information
regeneration. Application of these tissue-engineering methods (Langer and
Vacanti 1993; Skalak 1988) to musculoskeletal tissue regeneration has yielded
signifi cant advances whereby bone—(Agrawal and Ray 2001; Byers and Garcia
2004; El Ghannam, Ducheyne, and Shapiro 1995; Laurencin C.T. et al. 1999; Lu
et al. 2003; Mikos et al. 1993; Richardson et al. 2001; Shea et al. 2000; Yaszemski
et al. 1996; Zhang and Ma 1999), cartilage—(Almarza and Athanasiou 2004;
Caterson et al. 2002; Freed et al. 1993; Hung et al. 2003; Kim et al. 2003;
Klein et al. 2003; Li et al. 2005; Lu et al. 2001; Mauck et al. 2000; Riley et al. 2001;
Vunjak-Novakovic et al. 1996), ligament—(Altman et al. 2002; Cooper et al. 2005;
Dunn et al. 1995; Jackson, Heinrich, and Simon 1994; Lu et al. 2005; Musahl et al.
2004 ; Whitesides et al. 2001 ; Woo et al. 1999 ) and tendon - like — (Carpenter,
Thomopoulos, and Soslowsky 1999; Derwin et al. 2004; Garvin et al. 2003; Goh
et al. 2003; Juncosa et al. 2003; Zhang and Chang 2003) tissues have been engi-
neered
in vitro
and
in vivo
.
Building upon these successes, the emphasis in the fi eld of orthopedic tissue
engineering has recently shifted from tissue
formation
to tissue
function
(Butler,
Goldstein, and Guilak 2000). A critical area in the current functional tissue engi-
neering effort focuses on the integration of tissue engineered grafts with the host
environment as well as with each other. To this end, interface tissue engineering
has emerged as a promising strategy for achieving biological fi xation of tissue-
engineered soft tissue grafts, in particular with its emphasis on regenerating the
anatomic interface between soft tissues (that is, ligaments, tendons, cartilage) and
bone. Furthermore, this newly-engineered interface will serve as the bridge
between soft tissue and bone, and thereby enabling the development of inte-
grated musculoskeletal tissue systems for total joint replacement.
This chapter will discuss tissue engineering-based strategies for the regenera-
tion of the native interface between soft tissue and subchondral bone. It will begin
with a discussion of design considerations in interface tissue engineering. Subse-
quently, using the anterior cruciate ligament-to-bone interface as a model system,
current efforts in orthopedic interface tissue engineering will be reviewed.
Existing challenges and future directions in this emerging area will also be
presented.
17.2 DESIGN CONSIDERATIONS IN INTERFACE TISSUE ENGINEERING
In the musculoskeletal system, soft tissues such as ligaments—which connect
bone to bone—or tendons—which join muscle to bone—must integrate seam-
lessly with subchondral bone in order to function in unison to facilitate physio-
logic joint motion. The insertion of ligaments or tendons into subchondral bone is
often achieved through a characteristic fi brocartilage interface with well-defi ned
spatial variations in cell type and matrix composition (Benjamin et al. 1991;
Benjamin, Evans, and Copp 1986; Cooper and Misol 1970; Messner 1997; Niyibizi
et al. 1995; Niyibizi et al. 1996; Petersen and Tillmann 1999; Sagarriga et al. 1996;
Thomopoulos et al. 2003; Wang et al. 2006; Wei and Messner 1996). By design, this
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