Dissertation (Ph.D.) -- Worcester Polytechnic Institute. / Keywords: Ligament; ACL; Collagen; Fibrin; Microthread; Fiber; Thread; FGF-2; Fibroblast; Tissue regeneration; Tissue engineering. Includes bibliographical references.

Rupture of the anterior cruciate ligament (ACL) is a relatively common sports-related injury for which the current treatment is reconstruction with an autograft or allograft. Drawbacks associated with each of the current options would make a prosthetic alternative advantageous, however, artificial ligaments are not widely used, having failed due to lack of biocompatibility and mechanical insufficiencies. To develop the next-generation prosthetic ACL, design control principles were applied including specification of comprehensive design inputs, risk analysis, and verification testing. A design was proposed utilizing polyvinyl alcohol and ultrahigh molecular weight polyethylene, selected for good biocompatibility and mechanical strength and stiffness suitable for ACL replacement. A biomimetic fibrous rope pattern was designed for the intra-articular ligament section of the prosthetic that produced a close match the static tensile behavior of the native ACL and which also demonstrated good resistance to fatigue and creep. A calcium phosphate coating was recommended for the sections of the device lying within the bone tunnel to increase the rate of osseointegration. The proposed design was then evaluated in a computational simulation to assess functional restoration and the effects of installation parameters such as tension and tunnel orientation on knee kinematics. The encouraging results of preclinical verification testing support further in vivo evaluation of the proposed design.

Ligament/tendon tissue engineering has the potential to provide therapies that overcome the limitations of incomplete natural healing responses and inadequate graft materials. While ligament/tendon fibroblasts are an obvious choice of cell type for these applications, difficulties associated with finding a suitable cell source have limited their utility. Mesenchymal stem cells/marrow stromal cells (MSCs) are seen as a viable alternative since they can be harvested through routine medical procedures and can be differentiated toward a ligament/tendon fibroblast lineage. Further study is needed to create an optimal biomaterial/biomechanical environment for ligament/tendon fibroblastic differentiation of MSCs. The overall goal of this dissertation was to improve the understanding of the role that biomechanical stimulation and the biomaterial environment play, both independently and combined, on human MSC (hMSC) differentiation toward a ligament/tendon fibroblast phenotype. Specifically, the effects of cyclic tensile stimuli were studied in a biomaterial environment that provided controlled presentation of biological moieties. The influence of an enzymatically-degradable biomaterial environment on hMSC differentiation was investigated by creating biomaterials containing enzymatically-cleavable moieties. The role that preculture may play in tensile responses of hMSCs was also explored. Together, these studies provided insights into the contributions of the biomaterial and biomechanical environment to hMSC differentiation toward a ligament/tendon fibroblast phenotype.

Rupture of the anterior cruciate ligament (ACL) of the knee leads to chronic joint instability and reduced range of motion while the long term results are marred by a high prevalence of degenerative joint disease especially osteoarthritis. Bundles of collagen threads have been widely investigated for the repair of torn ACL, but are limited by insufficient tissue ingrowth to repopulate and completely regenerate these grafts. We have developed a novel in vitro method of characterizing fiber-based thread matrices by probing their ability to promote tissue ingrowth from a wound margin as a measure of their ability to promote repopulation and regeneration. This method is useful in the optimization of thread scaffolds, and is sensitive enough to distinguish between subtle variations in biopolymer chemistry and organization. Furthermore, this method was used to characterize the effects of crosslinking on the cell outgrowth and correlated the findings with the mechanical properties of collagen threads. The results suggest that crosslinking is required to achieve sufficient mechanical properties for high stress applications such as ACL replacement, but regardless of technique, crosslinking attenuated the cell outgrowth properties of the threads. To improve the regenerative capacity of these scaffolds, novel fibrin microthread matrices were developed with a similar morphology to collagen threads and sufficient mechanical strength to be incorporated in composite thread scaffold systems. These fibrin microthreads were loaded with FGF-2, a potent mitogen and chemotactic agent that works synergistically with fibrin in regulating cell signaling and gene expression. Increases in fibroblast migration and proliferation in FGF-2-loaded fibrin threads were successfully demonstrated with the concomitant promotion of oriented, aligned, spindle-like fibroblast morphology. These results suggest that fibrin-FGF-2 microthreads have distinct advantages as a biomaterial for the rapid regeneration of injured tissues such as the ACL.