So far, various clinical treatments have been available to alleviate symptoms and improve life quality to some extent, including microfracture technology, mosaicplasty, subchondral drilling, chondral shaving, abrasion arthroplasty, auto/allografts and joint replacement surgery ( Redman et al., 2005 Gracitelli et al., 2016). Moreover, different gradients of OC tissue have heterogeneous microstructures and biological properties ( Ansari et al., 2019). The upper articular cartilage possesses a stratified structure with no lymphatic or vascular components, lacking the capability of self-rehabilitation ( Le et al., 2021). By 2030, approximately 67 millions people are expected to suffer from OA in the United States ( Murphy and Helmick, 2012 Zhao et al., 2019). At the same time, OA can exacerbate the defects as a major cause. As a common degenerative disease worldwide with high socioeconomic burdens, osteoarthritis (OA) is an adverse outcome of OC defects ( Kwon et al., 2019). Resulting from trauma, athletic injury or pathological factors, early localized osteochondral lesions can lead to general tissue deterioration, characterized clinically by severe pain and functional incapacitation of the affected joints ( Hunter and Bierma-Zeinstra, 2019).
The management and repair of osteochondral (OC) defects are still one of the most challenging clinical issues in orthopedics. In this review, we summarize the complicated gradients of natural OC tissue and then discuss various osteochondral tissue engineering strategies, focusing on scaffold design with abundant cell resources, material types, fabrication techniques and functional properties. Unfortunately, due to the inherent complexity of organizational structure and the objective limitations of manufacturing technologies and biomaterials, we have not yet achieved stable and satisfactory effects of OC defects repair. Numerous scaffold types, such as porous, hydrogel, fibrous, microsphere, metal, composite and decellularized matrix, have been reported and evaluated for OC tissue regeneration in vitro and in vivo, with respective advantages and disadvantages. As an essential component of tissue engineering, scaffolds provide structural and functional support for cell growth and differentiation. Over centuries, several advances have been made in osteochondral (OC) tissue engineering to regenerate more biomimetic tissue. 4University of Chinese Academy of Sciences, Beijing, China.3Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing, China.2Institute of Sports Medicine of Peking University, Beijing, China.1Department of Sports Medicine, Peking University Third Hospital, Beijing, China.Jiang-Nan Fu 1,2 † Xing Wang 3,4 † Meng Yang 1,2 † You-Rong Chen 1,2 Ji-Ying Zhang 1,2 Rong-Hui Deng 1,2 Zi-Ning Zhang 1,2 Jia-Kuo Yu 1,2* Fu-Zhen Yuan 1,2*
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