[Frontiers in Bioscience E3, 923-944, June 1, 2011]

Regenerative medicine and tissue engineering in orthopaedic surgery

Alan Ivkovic1,2, Inga Marijanovic3, Damir Hudetz1, Ryan M. Porter4, Marko Pecina5, Christopher H. Evans4

1Department of Orthopedic Surgery, University Hospital, Sveti Duh, Zagreb, Croatia, 2Department of Biotechnology, University of Rijeka, Croatia, 3Department of Molecular Biology, Faculty of Science, University of Zagreb, Croatia, 4Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA, 5Department of Orthopedic Surgery, Medical School University of Zagreb, Croatia


1. Abstract
2. Introduction
3. Cells
3.1. Basic concepts
3.2. Differentiated cells
3.3. Stem cells
4. Environment
4.1. Inductive signals for cartilage regeneration
4.1.1. General principles
4.1.2. Growth factors and hormones
4.1.3. Transcription factors
4.1.4. Anticatabolic factors
4.1.5. Mechanical forces
4.2. Inductive signals for bone regeneration
4.2.1. Growth factors and hormones
4.2.2. Small molecules
4.2.3. Transcription factors
4.2.4. Mechanical forces
5. Scaffolds
5.1. Scaffolds for cartilage repair and regeneration
5.2. Scaffolds for bone regeneration
6. Potential clinical translation
6.1. Cartilage repair and regeneration
6.2. Bone regeneration
7. Outlook
8. References


Orthopedic surgery is going through a serious paradigm shift; instead of simply replacing damaged tissues with prosthetic or allograft material, the aim is to regenerate them. This endeavor has generated the field of regenerative orthopaedics, an increasingly expanding area of research with hopes of providing new and better treatments for diseases and injuries affecting the musculoskeletal system. As part of this process, we are witnessing a substantial accumulation of new cellular and molecular insights into connective tissue function, coupled with emerging new concepts in stem cell biology and scaffolding technologies. Indeed, any successful strategy to regenerate musculoskeletal tissues can be portrayed as an intricate interplay between the three main constituents of the regenerative system: cells, environment and scaffolds. This review is not meant to be exhaustive and comprehensive, but aims to highlight concepts and key advances in the field of regenerative orthopaedics and tissue engineering, as well as to present current possibilities for clinical translation.