Strong living scaffolds for load-bearing musculoskeletal tissue regeneration

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)

Load-bearing musculoskeletal tissues, including bone, cartilage, tendon, ligament, and skeletal muscle, possess highly specialized biological and biomechanical properties that enable weight support, movement, and protection of vital organs. However, intrinsic limitations in self-healing and exposure to complex physiological forces render them particularly vulnerable to injury and degeneration, resulting in musculoskeletal disorders with significant global impact. Current clinical solutions, ranging from bioinert metallic or polymeric implants to bioinductive, biodegradable scaffolds, provide temporary mechanical stabilization or promote tissue remodeling, yet often fail to achieve simultaneous mechanical robustness and biological functionality. To overcome these limitations, regenerative scaffolds incorporating living cells have emerged as a new paradigm. Nevertheless, conventional cell-laden hydrogels suffer from inadequate load-bearing capacity, whereas polymer scaffolds, although mechanically robust, lack the biological microenvironment to support functional regeneration. Recent research has therefore focused on developing strong living scaffolds that integrate toughness and cytocompatibility through two main approaches: mechanical reinforcement of cell-laden hydrogels and design of polymer-hydrogel hybrid scaffolds. This review summarizes the biology and biomechanics of loa

Evidence level

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

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