The osteochondral regeneration paradox: why biomimetic scaffolds are biologically superior but injectable systems dominate the clinic

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Musculoskeletal disorders (MSDs), particularly articular cartilage injuries and the progression of osteoarthritis (OA), represent a substantial global health burden. Conventional techniques fail to consistently achieve durable regeneration, yielding biomechanically inferior fibrocartilage due to the native tissue's avascularity and complex zonal architecture. This review translates the critical biological, mechanical, and architectural requirements of the osteochondral unit into quantitative design targets and critically evaluates two major regenerative strategies: structurally precise architected biomimetic scaffolds and minimally invasive injectable hydrogels. Our analysis reveals a fundamental trade-off between technical potential and translational feasibility. Architected scaffolds, fabricated using advanced methods like 3D printing and melt electrowriting, demonstrate superior capacity to meet structural demands. They achieve precise zonal stiffness gradients, secure bone anchorage, and immediate high-load-bearing capability necessary for long-term chondrocyte phenotype stabilization and faithful tissue reconstruction. In contrast, injectable hydrogels excel in defect conformability, logistical simplicity, and microenvironmental programming ( e.g. , controlled growth factor release, viscoelastic tuning), offering a patient-friendly, single-stage delivery. However, clinical

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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