J Wrist Surg 2021; 10(06): 492-501
DOI: 10.1055/s-0041-1729993
Special Review: The Scapholunate Dilemma

Additive Manufacturing: The Next Generation of Scapholunate Ligament Reconstruction

Matthew N. Rush
1   Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
,
1   Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
2   Center for Biomedical Engineering, The University of New Mexico, Albuquerque, New Mexico
3   Department of Mechanical Engineering, The University of New Mexico, Albuquerque, New Mexico
,
Lorraine Mottishaw
1   Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
2   Center for Biomedical Engineering, The University of New Mexico, Albuquerque, New Mexico
,
Damian Fountain
1   Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
4   Department of Biochemistry and Molecular Biology, The University of New Mexico, Albuquerque, New Mexico
,
1   Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
› Author Affiliations
Funding This research was supported in part by the NIH through a Research Supplement to Promote Diversity in Health-Related Research (UL1TR001449) as well as the American Foundation for Surgery of the Hand, Basic Science Research Grant (2016–2018), both awarded to C.S.

Abstract

Background Ligament reconstruction, as a surgical method used to stabilize joints, requires significant strength and tissue anchoring to restore function. Historically, reconstructive materials have been fraught with problems from an inability to withstand normal physiological loads to difficulties in fabricating the complex organization structure of native tissue at the ligament-to-bone interface. In combination, these factors have prevented the successful realization of nonautograft reconstruction.

Methods A review of recent improvements in additive manufacturing techniques and biomaterials highlight possible options for ligament replacement.

Description of Technique In combination, three dimensional-printing and electrospinning have begun to provide for nonautograft options that can meet the physiological load and architectures of native tissues; however, a combination of manufacturing methods is needed to allow for bone-ligament enthesis. Hybrid biofabrication of bone-ligament tissue scaffolds, through the simultaneous deposition of disparate materials, offer significant advantages over fused manufacturing methods which lack efficient integration between bone and ligament materials.

Results In this review, we discuss the important chemical and biological properties of ligament enthesis and describe recent advancements in additive manufacturing to meet mechanical and biological requirements for a successful bone–ligament–bone interface.

Conclusions With continued advancement of additive manufacturing technologies and improved biomaterial properties, tissue engineered bone-ligament scaffolds may soon enter the clinical realm.



Publication History

Received: 22 October 2020

Accepted: 06 April 2021

Article published online:
21 June 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 de Putter CE, Selles RW, Polinder S, Panneman MJM, Hovius SER, van Beeck EF. Economic impact of hand and wrist injuries: health-care costs and productivity costs in a population-based study. J Bone Joint Surg Am 2012; 94 (09) e56
  • 2 Labor USDo. Nonfatal occupational injuries and illnesses requiring days away from work, 2015. . Nov. 10, 2016. News Release USDL-16–2130. Accessed April 22, 2021 at: https://www.bls.gov/news.release/osh2.nr0.htm
  • 3 Murphy BD, Nagarajan M, Novak CB, Roy M, McCabe SJ. The epidemiology of scapholunate advanced collapse. Hand (N Y) 2020; 15 (01) 23-26
  • 4 Kani KK, Mulcahy H, Porrino J, Daluiski A, Chew FS. Update on operative treatment of scapholunate (SL) instability for radiologists: part 1-SL ligament repair, dorsal capsulodesis and SL ligament reconstruction. Skeletal Radiol 2017; 46 (12) 1615-1623
  • 5 Michelotti BF, Adkinson JM, Chung KC. Chronic scapholunate ligament injury: techniques in repair and reconstruction. Hand Clin 2015; 31 (03) 437-449
  • 6 Ward PJ, Fowler JR. Scapholunate ligament tears: acute reconstructive options. Orthop Clin North Am 2015; 46 (04) 551-559
  • 7 Dodds AL, Gupte CM, Neyret P, Williams AM, Amis AA. Extra-articular techniques in anterior cruciate ligament reconstruction: a literature review. J Bone Joint Surg Br 2011; 93 (11) 1440-1448
  • 8 Walsh JJ, Berger RA, Cooney WP. Current status of scapholunate interosseous ligament injuries. J Am Acad Orthop Surg 2002; 10 (01) 32-42
  • 9 Pinder RM, Brkljac M, Rix L, Muir L, Brewster M. Treatment of scaphoid nonunion: a systematic review of the existing evidence. J Hand Surg Am 2015; 40 (09) 1797.e3-1805.e3
  • 10 Luchetti R, Atzei A, Cozzolino R, Fairplay T. Current role of open reconstruction of the scapholunate ligament. J Wrist Surg 2013; 2 (02) 116-125
  • 11 Kakar S, Greene RM. Scapholunate ligament internal brace 360-degree tenodesis (SLITT) procedure. J Wrist Surg 2018; 7 (04) 336-340
  • 12 Di Benedetto P, Di Benedetto E, Fiocchi A, Beltrame A, Causero A. Causes of failure of anterior cruciate ligament reconstruction and revision surgical strategies. Knee Surg Relat Res 2016; 28 (04) 319-324
  • 13 van Eck CF, Schkrohowsky JG, Working ZM, Irrgang JJ, Fu FH. Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft. Am J Sports Med 2012; 40 (04) 800-807
  • 14 Getelman MH, Friedman MJ. Revision anterior cruciate ligament reconstruction surgery. J Am Acad Orthop Surg 1999; 7 (03) 189-198
  • 15 Vališ P, Sklenský J, Repko M, Rouchal M, Novák J, Otaševič T. [Most frequent causes of autologous graft failure in anterior cruciate ligament replacement [in Czech]. Acta Chir Orthop Traumatol Cech 2014; 81 (06) 371-379
  • 16 Corsetti JR, Jackson DW. Failure of anterior cruciate ligament reconstruction: the biologic basis. Clin Orthop Relat Res 1996; 325: 42-49
  • 17 Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF. Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 1993; 75 (12) 1795-1803
  • 18 Thomopoulos S, Williams GR, Gimbel JA, Favata M, Soslowsky LJ. Variation of biomechanical, structural, and compositional properties along the tendon to bone insertion site. J Orthop Res 2003; 21 (03) 413-419
  • 19 Whiston TB, Walmsley R. Some observations on the reactions of bone and tendon after tunnelling of bone and insertion of tendon. J Bone Joint Surg Br 1960; 42-B: 377-386
  • 20 Panni AS, Milano G, Lucania L, Fabbriciani C. Graft healing after anterior cruciate ligament reconstruction in rabbits. Clin Orthop Relat Res 1997; 343: 203-212
  • 21 van Kampen RJ, Bayne CO, Moran SL, Berger RA. Outcomes of capitohamate bone-ligament-bone grafts for scapholunate injury. J Wrist Surg 2015; 4 (04) 230-238
  • 22 Morrell NT, Weiss APC. Bone-retinaculum-bone autografts for scapholunate interosseous ligament reconstruction. Hand Clin 2015; 31 (03) 451-456
  • 23 Yao SH, Wang JP, Huang HK. Vascularized bone graft and scapholunate fixation for proximal scaphoid nonunion: a case report. Case Reports Plast Surg Hand Surg 2020; 7 (01) 83-87
  • 24 Berger RA. The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am 1996; 21 (02) 170-178
  • 25 Manske MC, Huang JI. The quantitative anatomy of the dorsal scapholunate interosseous ligament. Hand (N Y) 2019; 14 (01) 80-85
  • 26 Pappou IP, Basel J, Deal DN. Scapholunate ligament injuries: a review of current concepts. Hand (N Y) 2013; 8 (02) 146-156
  • 27 Qu D, Mosher CZ, Boushell MK, Lu HH. Engineering complex orthopaedic tissues via strategic biomimicry. Ann Biomed Eng 2015; 43 (03) 697-717
  • 28 Rajan PV, Day CS. Scapholunate interosseous ligament anatomy and biomechanics. J Hand Surg Am 2015; 40 (08) 1692-1702
  • 29 Jeong JE, Park SY, Shin JY. et al. 3D printing of bone-mimetic scaffold composed of gelatin/β-tri-calcium phosphate for bone tissue engineering. Macromol Biosci 2020; 20 (12) e2000256
  • 30 PremVictor S, Kunnumpurathu J, Devi MGG, Remya K, Vijayan VM, Muthu J. Design and characterization of biodegradable macroporous hybrid inorganic-organic polymer for orthopedic applications. Mater Sci Eng C Mater Biol Appl 2017; 77: 513-520
  • 31 Zeng Y, Yan YZ, Yan HF. et al. 3D printing of hydroxyapatite scaffolds with good mechanical and biocompatible properties by digital light processing. J Mater Sci 2018; 53 (09) 6291-6301
  • 32 Wolfram U, Schwiedrzik J. Post-yield and failure properties of cortical bone. Review Bonekey Rep 2016; 5 (Aug): 829
  • 33 Daly AC, Cunniffe GM, Sathy BN, Jeon O, Alsberg E, Kelly DJ. 3D bioprinting of developmentally inspired templates for whole bone organ engineering. Adv Healthc Mater 2016; 5 (18) 2353-2362
  • 34 Totaro A, Salerno A, Imparato G, Domingo C, Urciuolo F, Netti PA. PCL-HA microscaffolds for in vitro modular bone tissue engineering. J Tissue Eng Regen Med 2017; 11 (06) 1865-1875
  • 35 Li Q, Lei X, Wang X, Cai Z, Lyu P, Zhang G. Hydroxyapatite/collagen three-dimensional printed scaffolds and their osteogenic effects on human bone marrow-derived mesenchymal stem cells. Tissue Eng Part A 2019; 25 (17–18): 1261-1271
  • 36 Pang EQ, Douglass N, Behn A, Winterton M, Rainbow MJ, Kamal RN. Tensile and torsional structural properties of the native scapholunate ligament. J Hand Surg Am 2018; 43 (09) 864.e1-864.e7
  • 37 Eleswarapu SV, Responte DJ, Athanasiou KA. Tensile properties, collagen content, and crosslinks in connective tissues of the immature knee joint. PLoS One 2011; 6 (10) e26178
  • 38 Pauly HM, Sathy BN, Olvera D. et al. * Hierarchically structured electrospun scaffolds with chemically conjugated growth factor for ligament tissue engineering. Tissue Eng Part A 2017; 23 (15–16): 823-836
  • 39 Pauly HM, Kelly DJ, Popat KC. et al. Mechanical properties and cellular response of novel electrospun nanofibers for ligament tissue engineering: effects of orientation and geometry. J Mech Behav Biomed Mater 2016; 61: 258-270
  • 40 Wong S-C, Baji A, Leng S. Effect of fiber diameter on tensile properties of electrospun poly(ɛ-caprolactone). Polymer (Guildf) 2008; 49 (21) 4713-4722
  • 41 Cole BJ, Sayegh ET, Yanke AB, Chalmers PN, Frank RM. Fixation of soft tissue to bone: techniques and fundamentals. J Am Acad Orthop Surg 2016; 24 (02) 83-95
  • 42 Crema MD, Zentner J, Guermazi A, Jomaah N, Marra MD, Roemer FW. Scapholunate advanced collapse and scaphoid nonunion advanced collapse: MDCT arthrography features. AJR Am J Roentgenol 2012; 199 (02) W202-7
  • 43 Claudepierre P, Voisin MC. The entheses: histology, pathology, and pathophysiology. Joint Bone Spine 2005; 72 (01) 32-37
  • 44 Lin H, Beck AM, Shimomura K. et al. Optimization of photocrosslinked gelatin/hyaluronic acid hybrid scaffold for the repair of cartilage defect. J Tissue Eng Regen Med 2019; 13 (08) 1418-1429
  • 45 Kesti M, Eberhardt C, Pagliccia G. et al. Bioprinting complex cartilaginous structures with clinically compliant biomaterials. Adv Funct Mater 2015; 25 (48) 7406-7417
  • 46 Cooper JO, Bumgardner JD, Cole JA, Smith RA, Haggard WO. Co-cultured tissue-specific scaffolds for tendon/bone interface engineering. J Tissue Eng 2014; 5: 2041731414542294
  • 47 Spalazzi JP, Doty SB, Moffat KL, Levine WN, Lu HH. Development of controlled matrix heterogeneity on a triphasic scaffold for orthopedic interface tissue engineering. Tissue Eng 2006; 12 (12) 3497-3508
  • 48 Wang IE, Shan J, Choi R. et al. Role of osteoblast-fibroblast interactions in the formation of the ligament-to-bone interface. J Orthop Res 2007; 25 (12) 1609-1620
  • 49 Harris E, Liu Y, Cunniffe G. et al. Biofabrication of soft tissue templates for engineering the bone-ligament interface. Biotechnol Bioeng 2017; 114 (10) 2400-2411
  • 50 He P, Ng KS, Toh SL, Goh JC. In vitro ligament-bone interface regeneration using a trilineage coculture system on a hybrid silk scaffold. Biomacromolecules 2012; 13 (09) 2692-2703
  • 51 Li L, Li J, Zou Q, Zuo Y, Cai B, Li Y. Enhanced bone tissue regeneration of a biomimetic cellular scaffold with co-cultured MSCs-derived osteogenic and angiogenic cells. Cell Prolif 2019; 52 (05) e12658
  • 52 Carvalho MS, Silva JC, Udangawa RN. et al. Co-culture cell-derived extracellular matrix loaded electrospun microfibrous scaffolds for bone tissue engineering. Mater Sci Eng C 2019; 99: 479-490
  • 53 Gu Z, Fu J, Lin H, He Y. Development of 3D bioprinting: from printing methods to biomedical applications. Asian J Pharm Sci 2020; 15 (05) 529-557
  • 54 Nowlin J, Bismi MA, Delpech B, Dumas P, Zhou Y, Tan GZ. Engineering the hard-soft tissue interface with random-to-aligned nanofiber scaffolds. Nanobiomedicine (Rij) 2018; 5: 1849543518803538
  • 55 Yuan H, Zhou Q, Li B, Bao M, Lou X, Zhang Y. Direct printing of patterned three-dimensional ultrafine fibrous scaffolds by stable jet electrospinning for cellular ingrowth. Biofabrication 2015; 7 (04) 045004
  • 56 Sprio S, Campodoni E, Sandri M. et al. A graded multifunctional hybrid scaffold with superparamagnetic ability for periodontal regeneration. Int J Mol Sci 2018; 19 (11) E3604
  • 57 Fattahi P, Dover JT, Brown JL. 3D near-field electrospinning of biomaterial microfibers with potential for blended microfiber-cell-loaded gel composite structures, Adv Healthc Mater. 2017 6. 19,. 1700456
  • 58 He F-L, Li D-W, He J. et al. A novel layer-structured scaffold with large pore sizes suitable for 3D cell culture prepared by near-field electrospinning. Mater Sci Eng C 2018; 86: 18-27
  • 59 Luo G, Teh KS, Liu Y, Zang X, Wen Z, Lin L. Direct-write, self-aligned electrospinning on paper for controllable fabrication of three-dimensional structures. ACS Appl Mater Interfaces 2015; 7 (50) 27765-27770
  • 60 Bisht GS, Canton G, Mirsepassi A. et al. Controlled continuous patterning of polymeric nanofibers on three-dimensional substrates using low-voltage near-field electrospinning. Nano Lett 2011; 11 (04) 1831-1837
  • 61 Pan CT, Yen CK, Wang SY. et al. Energy harvester and cell proliferation from biocompatible PMLG nanofibers prepared using near-field electrospinning and electrospray technology. J Nanosci Nanotechnol 2018; 18 (01) 156-164
  • 62 Ren S, Yao Y, Zhang H. et al. Aligned fibers fabricated by near-field electrospinning influence the orientation and differentiation of hPDLSCs for periodontal regeneration. J Biomed Nanotechnol 2017; 13 (12) 1725-1734
  • 63 Fuh YK, Chen SZ, He ZY. Direct-write, highly aligned chitosan-poly(ethylene oxide) nanofiber patterns for cell morphology and spreading control. Nanoscale Res Lett 2013; 8 (01) 97
  • 64 Fuh YK, Wu YC, He ZY, Huang ZM, Hu WW. The control of cell orientation using biodegradable alginate fibers fabricated by near-field electrospinning. Mater Sci Eng C 2016; 62: 879-887
  • 65 Mosher CZ, Spalazzi JP, Lu HH. Stratified scaffold design for engineering composite tissues. Methods 2015; 84: 99-102
  • 66 Trachtenberg JE, Placone JK, Smith BT, Fisher JP, Mikos AG. Extrusion-based 3D printing of poly(propylene fumarate) scaffolds with hydroxyapatite gradients. J Biomater Sci Polym Ed 2017; 28 (06) 532-554
  • 67 Aboubakr SNS, Long L, Buksa CA, Fritch C, Salas C. 3D bioprinter + electrospinner for bone-ligament tissue engineering. Univ N M Orthop Res J 2017; 5 (01) 110-116
  • 68 Diaz-Gomez L, Smith BT, Kontoyiannis PD, Bittner SM, Melchiorri AJ, Mikos AG. Multimaterial segmented fiber printing for gradient tissue engineering. Tissue Eng Part C Methods 2019; 25 (01) 12-24
  • 69 Pilipchuk SP, Fretwurst T, Yu N. et al. Micropatterned scaffolds with immobilized growth factor genes regenerate bone and periodontal ligament-like tissues. Adv Healthc Mater 2018; 7 (22) e1800750
  • 70 Parry JA, Olthof MG, Shogren KL. et al. Three-dimension-printed porous poly(propylene fumarate) scaffolds with delayed rhBMP-2 release for anterior cruciate ligament graft fixation. Tissue Eng Part A 2017; 23 (7-8): 359-365
  • 71 Li X, Cheng R, Sun Z. et al. Flexible bipolar nanofibrous membranes for improving gradient microstructure in tendon-to-bone healing. Acta Biomater 2017; 61: 204-216
  • 72 Costa PF, Vaquette C, Zhang Q, Reis RL, Ivanovski S, Hutmacher DW. Advanced tissue engineering scaffold design for regeneration of the complex hierarchical periodontal structure. J Clin Periodontol 2014; 41 (03) 283-294
  • 73 Gwiazda M, Kumar S, Świeszkowski W, Ivanovski S, Vaquette C. The effect of melt electrospun writing fiber orientation onto cellular organization and mechanical properties for application in anterior cruciate ligament tissue engineering. J Mech Behav Biomed Mater 2020; 104: 103631
  • 74 Sudheesh Kumar PT, Hashimi S, Saifzadeh S, Ivanovski S, Vaquette C. Additively manufactured biphasic construct loaded with BMP-2 for vertical bone regeneration: a pilot study in rabbit. Mater Sci Eng C 2018; 92: 554-564
  • 75 Sun Y, Liu Y, Li S, Liu C, Hu Q. Novel compound-forming technology using bioprinting and electrospinning for patterning a 3D scaffold construct with multiscale channels. Micromachines (Basel) 2016; 7 (12) E238
  • 76 Criscenti G, Longoni A, Di Luca A. et al. Triphasic scaffolds for the regeneration of the bone-ligament interface. Biofabrication 2016; 8 (01) 015009
  • 77 Xu T, Binder KW, Albanna MZ. et al. Hybrid printing of mechanically and biologically improved constructs for cartilage tissue engineering applications. Biofabrication 2013; 5 (01) 015001
  • 78 Lui H, Bindra R, Baldwin J, Ivanovski S, Vaquette C. Additively manufactured multiphasic bone-ligament-bone scaffold for scapholunate interosseous ligament reconstruction. Adv Healthc Mater 2019; 8 (14) e1900133
  • 79 Dragomir-Daescu D, Salas C, Uthamaraj S, Rossman T. Quantitative computed tomography-based finite element analysis predictions of femoral strength and stiffness depend on computed tomography settings. J Biomech 2015; 48 (01) 153-161
  • 80 Faldini C, Mazzotti A, Belvedere C. et al. A new ligament-compatible patient-specific 3D-printed implant and instrumentation for total ankle arthroplasty: from biomechanical studies to clinical cases. J Orthop Traumatol 2020; 21 (01) 16