This review aims to address the current limitations in biomaterial scaffold-based treatment strategies for bone defect healing and suggests new, alternative approaches that merit further investigation. The question of whether the biomaterial scaffold properties should mimic the natural extracellular matrix of mature tissue or some phase of the dynamic range of tissues observed during the healing process is discussed. Additionally, the authors advocate for a biomimetic approach, which uses the endogenous secondary fracture healing processes to inform the design of scaffold constructs. In particular, the mechanical environment is emphasized as an important factor influencing the clinical success of these constructs. The authors stress the need for a scaffolds design that provides an optimal mechanical environment for cell fate, supplies necessary signals and nutrition to the cells and, thus, more closely mimics the natural healing cascade.
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