A Systematic Review on Preclinical and Clinical Studies on the Use of Scaffolds for Bone Repair in Skeletal Defects

Background: The management and treatment of bone defects caused by trauma, non-union, tumors and disease poses a major clinical problem. Limitations with autograft and allograft have led to research into tissue engineering of bone graft using scaffolds and mesenchymal stem cells. Objectives: This systematic review aims to examine and summarize the pre clinical in-vivo studies and the limited clinical studies on the use of scaffolds in the treatment of critical size bony defects. Data sources: Databases: PubMed, Medline, OVID, Scopus and Cochrane library. The following key words and search terms were used: scaffolds, bone repair, bone regeneration, mesenchymal stem cells, and tissue engineering and musculoskeletal. Methods: A total of 503 articles were reviewed. 23 articles were identified as relevant for the purpose of this systematic literature review. Results: Three tables of studies were constructed: pre clinical biological scaffolds, pre clinical synthetic scaffolds and clinical scaffolds. Conclusions: There is a lot of pre clinical evidence that the use of scaffold combined with mesenchymal stem cells enhances osteogenesis when treating bone defects. There is limited clinical evidence at this early stage that scaffolds can be used safely and effectively in tissue engineered grafts to repair bone defects with no RCTs as yet having been conducted. The limited clinical series reported have however produced promising results.