Two cartilage regeneration techniques are briefly covered: Autologous Chondrocyte Implantation (ACI) and Autologous Matrix-Induced Chondrogenesis (AMIC). ACI involves taking cartilage cells from a non-load bearing area, multiplying them in a lab, and re-injecting them into damaged cartilage in two surgeries. AMIC requires only one surgery - the damaged cartilage is removed, the area is stimulated with microfractures, and a collagen membrane placed over the site promotes new cartilage growth from stem cells. These techniques and bio-scaffold technologies offer potential long-term solutions for cartilage conditions and regeneration of original cartilage properties.

1. Cartilage Regeneration Techniques
By: Kareem Arafat
Numerousbiomaterialsandtechniqueshave beendevelopedovermanydecadestorepair
damage to the cartilage withinthe body. Unfortunately,nomethodhasbeenable tomatchthe
propertiesandbenefitsof healthynatural cartilage1
.Specificbiomaterials calledscaffoldsare utilizedto
promote the growthof natural cartilage onand withinthe biomaterial.Ascartilage growstorepairthe
damagedsite,the scaffoldwilleventuallydegrade.Thisblogwill brieflycovertworegenerativecartilage
techniques,AutologousChondrocyte Implantation(ACI)andAutologousMatrix InducedChondrogenesis
(AMIC).These twotechniqueswere developedtoreplace andregeneratehyaline cartilagewithinjoints
of the bodythat have damagedcartilage.Mostoften,ACIandAMIC techniquesare performedonthe
knee inlieuof total knee replacements,especiallyonyoungerpatients2
.Althoughthesetechniquesare
mostlyperformedinthe knee,theymayalsobe performedonthe hip,shoulder,elbow, ankle, andbig
toe.Many attemptshave beenmade toproduce a long-term, cost-effective,andbiocompatible scaffold;
however,mostattemptsfail toachieve this. Anexample wouldbe collagen-basedscaffolds.Collagenis
the body’smostabundantproteinandisthus highlybiocompatible.Unfortunately,collagen-based
scaffoldshave disappointinglong-termpropertiesincluding poorshape retentionandmechanical
strength.Many typesof these bio-scaffoldsexistincludingprotein-based,carbohydrate-based,polymer-
based,or a combinationof these.
AutologousChondrocyteImplantation(ACI) isatechnique forregeneratingthe hyaline cartilage
by implantingcartilagecells.The ACIprocedure takesplace intwosurgeriesforthe patient.Inthe first
surgery,the doctorwill take cartilage cellsfromadifferent,non-load-bearingareaof the body.Hyaline
cartilage can be foundinnon-loadbearingareasof the bodysuch as at the endsof ribs,in the nose,
larynx,trachea,andbronchi 1
. Thissample of cellswill be senttoa laboratorywhere the cellswill be
multiplieduntilthere are about5-10 millioncellsinthe culture;this usuallytakes 3-5weeks 3
.Once
there are enoughcells,the doctorperformsasecondsurgeryinwhichthe cellsare injectedbackinto
the bodyin the area inwhichthe cartilage isdamaged.
AutologousMatrix-InducedChondrogenesis(AMIC) isatechnique thatwasdevelopedin
Germanyto helpheal areasinwhichfull-thicknesscartilage hasbeen damaged:deepchondral and
subchondral lesions.Thisprocedure isdifferentfromthe ACIprocedure inwhichitonlyrequiresone
surgery.Inthissurgery,the damagedcartilage isremoved.The surgeonwill use abone marrow
stimulatingtechniquesuchas micro fracturingtorelease mesenchymal stemcells(MSCs) thatwill help
regenerate cartilage.Microfracture involvesdrillingmultiple holesintothe exposedbone approx. 3-
4mm apart 4
. Bone marrow andblood rush to the site forminga‘superclot’which,inturn,becomesthe
basisfor newtissue formation.The newlyroughsurface isideal forpromotingthisnew tissueformation.
The surgeonthenplacesa porcine collagenmembraneoverthe bleedingsite.Underneaththe
membrane,aclotthenforms fromthe free MSCs on the bone surface andhelpsstimulate chondrocyte
growth.The chondrocyte growththenregeneratescartilagetissue where the damagedcartilagewas
removed.

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The ACI and AMICtechniquesaswell asthe numerousbio-scaffoldtechnologiesofferenormous
capacityfor long-termsolutionstoseveral cartilageconditions.Soon,these technologiescanbe applied
to helpmitigate the effectsof cartilage degenerationdiseasesorinjuriesaffectingthe cartilage.Thisis
all inthe efforttoultimatelycreate arepairsystemthatrestoresthe original propertiesof natural,
biological cartilage.
EMMA International canassistyouwithall yourcompliance needs.Call ustodayat 248-987-
4497 or email usat info@emmainternational.com.
1Cartilage. “Cartilage Repair Techniques.” Patient Education,
ICRSCartilage.org/Content/Uploads/Icrs.jpg, 26 Mar. 2015,
cartilage.org/patient/about-cartilage/cartilage-repair/.
2Zellin, G, and A Gritli-Linde. “Healing of Mandibular Defects with Different Biodegradable
and Non-Biodegradable Membranes: an Experimental Study in Rats.” Biomaterials,
U.S. National Library of Medicine, 16 May 1995, pubmed.ncbi.nlm.nih.gov/7548610/.
3
Brittberg,Mats.“AutologousChondrocyte Implantation-Technique andLong-TermFollow-Up.”Injury,
Elsevier,6Mar. 2008, www.sciencedirect.com/science/article/pii/S0020138308000624.
4
Kelechi OkorohaMD, “AMIC of the Hip.” www.kelechiokorohamd.com/amic-of-the-hip-orthopaedic-
surgeon-sports-medicine-detroit-mi.html.