Robotic in situ bioprinting for cartilage tissue engineering

Articular cartilage damage caused by trauma or degenerative pathologies such as osteoarthritis can result in significant pain, mobility issues, and disability. Current surgical treatments have a limited capacity for efficacious cartilage repair, and long-term patient outcomes are not satisfying. Three-dimensional bioprinting has been used to fabricate biochemical and biophysical environments that aim to recapitulate the native microenvironment and promote tissue regeneration. However, conventional in vitro bioprinting has limitations due to the challenges associated with the fabrication and implantation of bioprinted constructs and their integration with the native cartilage tissue. In situ bioprinting is a novel strategy to directly deliver bioinks to the desired anatomical site and has the potential to overcome major shortcomings associated with conventional bioprinting. In this review, we focus on the new frontier of robotic-assisted in situ bioprinting surgical systems for cartilage regeneration. We outline existing clinical approaches and the utilization of robotic-assisted surgical systems. Handheld and robotic-assisted in situ bioprinting techniques including minimally invasive and non-invasive approaches are defined and presented. Finally, we discuss the challenges and potential future perspectives of in situ bioprinting for cartilage applications.