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Large segmental gaps in bone caused by trauma or disease are typically treated with bone grafts and stiff scaffolds to hold the fractured bone in place, but sometimes these defects fail to heal. To optimize bone regeneration, Pobloth and colleagues modified titanium-mesh scaffold designs to provide specific strains and stresses within the fracture environment. In sheep with critical-sized segmental defects, scaffolds that reduced stress shielding around tibial fractures enhanced bone bridging compared to stiffer scaffolds and shielding plates. Scaffolds can be tuned to evoke specific mechanical and biological responses within bone defects, which could help guide regeneration.Three-dimensional (3D) titanium-mesh scaffolds offer many advantages over autologous bone grafting for the regeneration of challenging large segmental bone defects. Our study supports the hypothesis that endogenous bone defect regeneration can be promoted by mechanobiologically optimized Ti-mesh scaffolds. Using finite element techniques, two mechanically distinct Ti-mesh scaffolds were designed in a honeycomb-like configuration to minimize stress shielding while ensuring resistance against mechanical failure. Scaffold stiffness was altered through small changes in the strut diameter only. Honeycombs were aligned to form three differently oriented channels (axial, perpendicular, and tilted) to guide the bone regeneration process. The soft scaffold (0.84 GPa stiffness) and a 3.5-fold stiffer scaffold (2.88 GPa) were tested in a critical size bone defect model in vivo in sheep. To verify that local scaffold stiffness could enhance healing, defects were stabilized with either a common locking compression plate that allowed dynamic loading of the 4-cm defect or a rigid custom-made plate that mechanically shielded the defect. Lower stress shielding led to earlier defect bridging, increased endochondral bone formation, and advanced bony regeneration of the critical size defect. This study demonstrates that mechanobiological optimization of 3D additive manufactured Ti-mesh scaffolds can enhance bone regeneration in a translational large animal study.
