Adhesive Hydrogels as Fixation and Regeneration Platforms in Cartilage Surgery: Rethinking Scaffold-Tissue...

Area of Science:

• Biomaterials Science
• Orthopedic Surgery
• Regenerative Medicine

Background:

• Articular cartilage defects present a significant orthopedic challenge due to the tissue's limited healing capacity.
• Current surgical methods like microfracture, autologous chondrocyte implantation (ACI/MACI), and osteochondral grafting have high failure rates (15-75% at 5 years) primarily due to inadequate adhesion.
• Adhesion is identified as the critical factor determining the success of cartilage repair constructs.

Purpose of the Study:

• To re-evaluate the role of adhesion as the central determinant in cartilage repair success.
• To systematically assess biomechanical demands and define adhesion thresholds in the joint environment.
• To review adhesive hydrogel strategies for various surgical contexts and delivery methods.

Main Methods:

• Systematic evaluation of biomechanical joint environment demands and adhesion thresholds.
• Categorization of adhesive hydrogel strategies by surgical application (microfracture, ACI/MACI, grafting, standalone).
• Analysis of material platforms (catechol/dopamine, NHS ester, photocrosslinkable, supramolecular, hybrid) and injectable formulations.

Main Results:

• Adhesive hydrogels offer a promising solution to overcome the inadequate adhesion failure mode in current cartilage repair techniques.
• Various hydrogel chemistries and formulations are suitable for different surgical needs, including arthroscopic delivery.
• Key translational challenges such as durability, biocompatibility, sterilization, and regulatory hurdles were identified.

Conclusions:

• Adhesive hydrogels are the missing link for improving current cartilage repair paradigms.
• Future research should focus on 4D bioprinting, AI optimization, and stimuli-responsive systems.
• Addressing translational barriers is essential for the clinical implementation of adhesive hydrogel technologies.