There is currently a lack of clinically available solutions to restore functionality to the intervertebral disk (IVD) following herniation injury to the annulus fibrosus (AF). Microdiscectomy is a commonly performed surgical procedure to alleviate pain caused by herniation; however, AF defects remain and can lead to accelerated degeneration and painful conditions. Currently available AF closure techniques do not restore mechanical functionality or promote tissue regeneration, and have risk of reherniation. This review determined quantitative design requirements for AF repair materials and summarized currently available hydrogels capable of meeting these design requirements by using a series of systematic PubMed database searches to yield 1500+ papers that were screened and analyzed for relevance to human lumbar in vivo measurements, motion segment behaviors, and tissue level properties. We propose a testing paradigm involving screening tests as well as more involved in situ and in vivo validation tests to efficiently identify promising biomaterials for AF repair. We suggest that successful materials must have high adhesion strength (∼0.2 MPa), match as many AF material properties as possible (e.g., approximately 1 MPa, 0. 3 MPa, and 30 MPa for compressive, shear, and tensile moduli, respectively), and have high tensile failure strain (∼65%) to advance to in situ and in vivo validation tests. While many biomaterials exist for AF repair, few undergo extensive mechanical characterization. A few hydrogels show promise for AF repair since they can match at least one material property of the AF while also adhering to AF tissue and are capable of easy implantation during surgical procedures to warrant additional optimization and validation.
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February 2016
Research-Article
Design Requirements for Annulus Fibrosus Repair: Review of Forces, Displacements, and Material Properties of the Intervertebral Disk and a Summary of Candidate Hydrogels for Repair
Rose G. Long,
Rose G. Long
Icahn School of Medicine at Mount Sinai,
Leni and Peter W. May Department of
Orthopaedics,
New York, NY 10029;
Leni and Peter W. May Department of
Orthopaedics,
New York, NY 10029;
Collaborative Research Partner Annulus Fibrosus
Rupture Program of AO Foundation,
Davos 7270, Switzerland
e-mail: rose.long@mssm.edu
Rupture Program of AO Foundation,
Davos 7270, Switzerland
e-mail: rose.long@mssm.edu
Search for other works by this author on:
Olivia M. Torre,
Olivia M. Torre
Icahn School of Medicine at Mount Sinai,
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: olivia.torre@icahn.mssm.edu
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: olivia.torre@icahn.mssm.edu
Search for other works by this author on:
Warren W. Hom,
Warren W. Hom
Icahn School of Medicine at Mount Sinai,
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: warren.hom@mssm.edu
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: warren.hom@mssm.edu
Search for other works by this author on:
Dylan J. Assael,
Dylan J. Assael
Icahn School of Medicine at Mount Sinai,
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: dylan.assael@icahn.mssm.edu
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: dylan.assael@icahn.mssm.edu
Search for other works by this author on:
James C. Iatridis
James C. Iatridis
Icahn School of Medicine at Mount Sinai,
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029;
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029;
Collaborative Research Partner Annulus Fibrosus
Rupture Program of AO Foundation,
Davos 7270, Switzerland
e-mail: james.iatridis@mssm.edu
Rupture Program of AO Foundation,
Davos 7270, Switzerland
e-mail: james.iatridis@mssm.edu
Search for other works by this author on:
Rose G. Long
Icahn School of Medicine at Mount Sinai,
Leni and Peter W. May Department of
Orthopaedics,
New York, NY 10029;
Leni and Peter W. May Department of
Orthopaedics,
New York, NY 10029;
Collaborative Research Partner Annulus Fibrosus
Rupture Program of AO Foundation,
Davos 7270, Switzerland
e-mail: rose.long@mssm.edu
Rupture Program of AO Foundation,
Davos 7270, Switzerland
e-mail: rose.long@mssm.edu
Olivia M. Torre
Icahn School of Medicine at Mount Sinai,
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: olivia.torre@icahn.mssm.edu
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: olivia.torre@icahn.mssm.edu
Warren W. Hom
Icahn School of Medicine at Mount Sinai,
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: warren.hom@mssm.edu
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: warren.hom@mssm.edu
Dylan J. Assael
Icahn School of Medicine at Mount Sinai,
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: dylan.assael@icahn.mssm.edu
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029
e-mail: dylan.assael@icahn.mssm.edu
James C. Iatridis
Icahn School of Medicine at Mount Sinai,
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029;
Leni and Peter W. May Department of
Orthopaedics,
One Gustave Levy Place, Box 1188,
New York, NY 10029;
Collaborative Research Partner Annulus Fibrosus
Rupture Program of AO Foundation,
Davos 7270, Switzerland
e-mail: james.iatridis@mssm.edu
Rupture Program of AO Foundation,
Davos 7270, Switzerland
e-mail: james.iatridis@mssm.edu
1Corresponding author.
Manuscript received August 26, 2015; final manuscript received December 8, 2015; published online January 27, 2016. Editor: Beth A. Winkelstein.
J Biomech Eng. Feb 2016, 138(2): 021007 (14 pages)
Published Online: January 27, 2016
Article history
Received:
August 26, 2015
Revised:
December 8, 2015
Citation
Long, R. G., Torre, O. M., Hom, W. W., Assael, D. J., and Iatridis, J. C. (January 27, 2016). "Design Requirements for Annulus Fibrosus Repair: Review of Forces, Displacements, and Material Properties of the Intervertebral Disk and a Summary of Candidate Hydrogels for Repair." ASME. J Biomech Eng. February 2016; 138(2): 021007. https://doi.org/10.1115/1.4032353
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