Piezoelectric nanocellulose derivatives combine the electromechanical properties of cellulose nanocrystals with chemically compatible functionalization and nanocomposite fabrication approaches, aiming to design biocompatible, mechanically similar cartilage monitors. Focusing on scalable, clinically relevant objects, this review assesses design choices, fabrication methods, and translation challenges. It covers surface derivatisation, polymer matrix reinforcement, and alignment techniques achieved through electrospinning, 3D printing, thin-film deposition, and scaffold integration with microelectronics, using standardised mechanical loading protocols. Mechanical piezoelectric nanocellulose biosensors offer real-time, minimally invasive, tissue-matched mechano-electrical signals to predict early cartilage degeneration, facilitate earlier diagnosis, enable personalised closed-loop rehabilitation, support self-powered telemetry, and streamline clinical translation. Enhanced responses are observed in oriented nanofibers, conductive or piezo-enhancing matrices, and specific surface chemistries, resulting in prototype sensors capable of measuring physiological cartilage pressures and strains with desirable signal-to-noise ratios in benchtop models, with potential for wireless telemetry with low power consumption. Major challenges include achieving consistent large-scale orientation under synovial conditions, ensuring long-term performance in vivo , and enabling reproducible wireless readouts and encapsulations. In conclusion, piezoelectric nanocellulose offers a sustainable, promising pathway to next-generation, sensitive, and potentially self-powered cartilage sensors. Future research should focus on scalable production, in vivo validation, open data for reproducibility, interdisciplinary collaboration with clinicians, and establishing quantitative performance metrics. Progress in these areas holds the potential to accelerate the clinical application of diagnostic and rehabilitation devices.
Priya et al. (Tue,) studied this question.