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3D Printing
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3D Printing

3D printing is the layer-by-layer deposit of materials to create objects with complex but well-defined structures. Combining previous discoveries in engineering, bioreactor design and biomaterial scaffolds, 3D printing can also be used to create biomaterial scaffolding for human cells. This printing has been further developed to include the printing of living cells.

To achieve that, the whole process of 3D printing has been redesigned. 3D printing is traditionally based on the deposition of melted polymers or metals. That requires temperatures far higher than a living cell could survive. Therefore, novel materials such as gelatin-based hydrogels are now used, as they can be printed at temperatures that cells can withstand. Combining hydrogels with cells (known as bioinks), creates what could be termed a ‘biological colour printer’. Layer by layer, constructs can be made in which cells can be organised to resemble the real 3D structure of a tissue.

This is obviously not yet a clinical reality. What is a clinical reality is that cells and cell therapy can be used to improve cartilage defects – including the regeneration, but more likely the repair, of cartilage defects. With 3D bioprinting, the aim is to take the next step and create more natural cartilage tissue for implantation into defective cartilage. For patients, the benefit could be improved function and a longer lasting outcome.

Intended audience

This information is aimed at patients who have been identified as having cartilage defects. It is designed to offer an overview of 3D printing, as well as briefly discuss the future potential uses of the technique.

What are the potential advantages of 3D printing?

The major advantage of 3D printing is that it may address some of the complexities of the tissues. For example, an implant could replicate some of the layered structure of the cartilage (https://youtube/ukul0bi9ytI), or even the layered structure of the osteochondral tissue – in other words, the cartilage plus the underlying bone.

For that, cells could be taken from the patient. With a 3D printer in the hospital, close to the operating theatre, it may even be possible one day to create the replacement tissue on-site and implant it in a one-stage procedure.

Another advantage of 3D printing is that it may require less tissue handling than other approaches, and the automated process may help with the sizing of implants.

Which types of cartilage defect could be suitable for 3D printing?

The defect that is likely to benefit the most from 3D printing is the ‘focal defect’. This means direct and specific damage to the cartilage due to trauma or an accident. Such defects can affect anyone, including athletes.

However, the uses of this technology may, in the future, go even further. 3D printing could be used to treat damage to the whole of one side of the patella or the degeneration of a whole joint, such as the knee.

When will 3D printing become available?

This is a very difficult question. 3D printing is an innovative approach that is at least two steps ahead of what’s being carried out now, and can be expected 10–15 years down the line. The technology is not yet approaching clinical reality, and is in the pre-development phase. However, this is something that scientists are focusing on now.

Nevertheless, 3D printing is a booming technology that is developing extremely quickly. The robotics and electronics that underpin this technology are also developing quickly. 3D printing is ‘hitchhiking’ on the back of these developments, but using a more biological approach to integrate all of these technologies.

From the perspective of current care, marrow stimulation (drilling or microfracture), osteochondral grafts, scaffoldsor cell therapy remain the standard options for treating cartilage defects, with the choice of technique largely depending on the size of the defect. It may be that, in the future, there will be a third option, in which cell therapy is enhanced by using 3D printing to improve the accuracy of cell and biomaterial placement.

All of these issues are currently being examined in a large, Europe-wide project with 17 different partners. The aim is to find out if 3D printing improves patient outcomes by creating a structure that can mimic the layered structure of cartilage. Furthermore, it is important to find out whether this promising technique can be translated to humans.

Further reading

To find out more about 3D printing and how it is being developed for clinical use, please visit HydroZONES.

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