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3D Bioprinting technology for tissue regeneration and weight bearing bone reconstruction. The current focus will be on addressing the limitations of traditional allografting and autografts for bone regeneration using 3D bioprinting technology. Biomaterial innovations and technologies will be the cornerstone to fabricate complex three-dimensional bone constructs with precise control for ankle and foot defects.

Introduction

3D bioprinting has remarkably reshaped the healthcare industry, offering new opportunities to print organ like structures and tissues that mimic function of living tissues needed for structural support. Although, this groundbreaking bioprinting technology is still at early stage, it offers incredible direction to manage bone defects in the foot and ankle. Over the years, autografting and allografting methodology is used for bone grafting. These methodologies poses certain limitations, such as morbidity, donor site pain and variability rates of resorption.

3D bioprinting emerged as a promising approach to fabricate patient specific bone constructs by using 3D printers and biomaterials. Furthermore, this technology combines AI and machine learning which helps to predict immune response in real-time, thereby eliminating the requirement of long processing for podiatric surgery to treat bone defects that occur due to trauma and injuries. As 3D bioprinting technology continue to be more advanced and accessible, this technology helps to mitigate the requirement for weight bearing bone structures for structural support in the foot and ankle.

3D Bioprinting Technologies for Weight Bearing Bone Tissue Engineering

The latest launched 3D bioprinting technology when combined with bioink and synthetic biomaterials enable the fabrication of complex 3D structure of tissues and organs that mimic the intricate organizations and cellular heterogeneity. With increasing awareness of 3D bioprinting and its potential role in healthcare industry, researchers are aiming to develop printing techniques with higher precision, higher resolution, and multi-material printing.

• Extrusion-Based Bioprinting

This technology involves continuous dispensing of bioinks and biomaterials through a nozzle to build a 3D structures layer by layer, making it ideal for creating scaffolds with high cell densities. The efficient formation of multiple cell types with scaffolds can mimic the biochemical environment of bone tissues that further will be used for the construction of patient-specific bone reconstruction to manage ankle and foot defects. Extrusion based bioprinting is specifically used for weight-bearing bone reconstruction applications due to its potential of creating robust scaffolds with higher concentration of cells / biomaterials.

• Laser-Assisted 3D Bioprinting

Laser-assisted 3D bioprinting also known as laser induced forward transfer technology enable non-contact 3D bioprinting of tissues / organs. This involves use of pulsed laser beam for depositing bio-ink onto the substrate for creating tissues and organ with high control over cell placement.

• Stereolithographic-Based 3D Bioprinting

This latest 3D bioprinting technology is typically based on the design rather than structure complexity. It utilize photo-sensitive heat-curable bio-ink that deposit in plane-by-plane fashion using scaffold polyethylene glycol.

Latest Innovations in Bioinks and Biomaterials for Weight-Bearing Bone Reconstruction

In order to create weight bearing bone structures, it is essential to select appropriate biomaterials and bioink formulations. Considering the ongoing necessity, the present focus of researchers will be on bioinks and biomaterial innovations.

• Advanced Bioink Materials

The focus will be on advanced bioink materials, such as gelatin, alignate, hydrouronic acid, synthetic polycaprolactone, hydrogels, polyether ether ketone and gelatin methacrylate. These material enhance printability, biocompatibility, mechanical strength, cell viability and osteoconductivity in weight bearing bone structures. The ability to print patient-specific weight bearing bone structure allow podiatrist to treat ankle and foot defects that typically occur due to trauma and other injuries.

Notably, the current focus of researchers in 3D bioprinting of bone tissue for in vitro modeling is to create suitable microenvironmental condition to stimulate and support cellular processes for bone remodeling and formation. Presently, hydrogels are excellent for replicating extracellular matrix required for bone remodeling.

• Mesenchymal Stem cells

Presently, mesenchymal stem cells are widely used as a biomaterial in designing weight bearing bone structures. These stem cells poses the osteogenic potential and growth factors, such as bone morphogenetic proteins that promote osteogenesis and vascularization for nutrient supply.

• Shape-Morphing Tissues

The current focus is on the development of new approach to bioprint tissue with capabilities of shape changing due to cell-generated forces. This structure can mimic the natural process of human organ, thereby indicating more potential of 3D bioprinting in creating mature bioprinted weight bearing bone structures. As more researchers continue to leverage 3D bioprinting technology, it is expected that weight bearing bone structure reconstruction will become easier.

• Vascular Networks

Earlier vascularization is a major challenge associated with 3D bioprinting. The development of perfusable microvascular networks due to its complex nature is challenging and require complex engineering tools.

One of the significant bottlenecks in 3D bioprinting is the establishment of functional vascularization to deliver nutrients and removal of waste material, such as carbon dioxide, cellular byproducts from cells / tissues, and chemicals waste. Notably, the development of perfusable microvascular networks within bioprinted constructs is a complex engineering task and replicating complex microarchitectures along with heterogeneous cell populations with currently available 3D bioprinting technology is a significant challenge.

Current Applications of 3D Bioprinting in Weight Bearing Bone Structures

Researchers have made a significant progress in 3D bioprinting allowing precise formation of scaffold designs and composite scaffolds that can mimic the trabecular structure of bones.

• Scaffold Design

Bioprinting technology helps to create porous scaffolds that can mimic the trabecular structure of bone, offering mechanical strength and promote cell infiltration. These scaffold designs can be customized using 3D bioprinting / 4D bioprinting for specific load bearing requirements, thereby holding immense potential in treating ankle and foot injuries.

• Composite Scaffolds

3D bioprinting also helps in designing composite scaffolds that combines mechanically strong biomaterial with bioactive components. This methodology allow the development of scaffolds that can withstand physiological loads and promote bone regeneration.

• Personalized Implants

Bioprinting helps to design tailored scaffolds and personalized implants using imaging data. These personalized implants play a significant role in addressing foot and ankle reconstructive surgeries.

3D Bioprinting Technology: The Future Focus

3D bioprinting holds an immense potential in healthcare industry. The current and future focus will be on the development of bioartificial materials that can help to address the current challenges faced by podiatrists in managing ankle and foot injuries. In addition to weight bearing bone structures, researchers are focusing on multi-material bioprinting, incorporation of nanomaterials and 4D bioprinting using smart materials.