Biomimetic fabrication bioprinting strategies based on decellularized extracellular matrix for musculoskeletal tissue regeneration: Current status and future perspectives

Musculoskeletal disorders, as one of the prevalent categories of ailments, exert significant impacts on individuals' lives, occupations, and physical activities. Degenerative changes, injuries, infections, and tumor resections causing defects in musculoskeletal tissues such as cartilage, bones, skeletal muscles, menisci, ligaments, and rotator cuffs can detrimentally affect patients' quality of life and mental well-being. Traditional autologous and allogeneic transplantations have been clinically employed. However, autologous transplantation suffers from the limitation of a finite number of transplantable tissues, while allogeneic transplantation faces challenges such as immune rejection. The extracellular matrix (ECM) serves as a natural scaffold for cells to fulfill physiological functions such as adhesion, proliferation, and differentiation. Decellularized extracellular matrix (dECM) emerges as a promising biomaterial generated through specific tissue or organ decellularization. Leveraging 3D bioprinting technology, dECM-based biomaterials enable customized printing and construction. This study reviews various decellularization techniques, post-decellularization strategies, and commonly used 3D bioprinting technologies. It summarizes the integration of dECM-based biomaterials with 3D bioprinting technology applied in musculoskeletal system research. These investigations showcase the exciting potential of dECM-based biomaterials in the musculoskeletal system, offering prospects for clinical translation in orthopedics.