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Autologous Matrix-Induced Chondrogenesis (AMIC®)
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Autologous Matrix-Induced Chondrogenesis (AMIC®)

Full-thickness cartilage damage, that is, damage that extends to the underlying subchondral bone, rarely heals spontaneously and often requires extended healing periods. Most full-depth chondral lesions will require an interventional therapy, usually surgery.

Bone marrow stimulating techniques, such as microfracturing (described elsewhere on this website), are used to free cells from the underlying bone. The resultant super clot contains undifferentiated chondrocyte precursor cells, known as mesenchymal stem cells (MSCs), which can help regenerate cartilage. The super clot is covered with a membrane to protect the MSCs and keep them in place. The super clot, protected by the membrane, is a perfect environment for the differentiation and growth of MSCs and the regeneration of the cartilage in an even and functional manner, during which time the membrane is resorbed. This new tissue can eventually form hyaline-like cartilage, allowing resumption of normal activity even in sport professionals.

Autologous Matrix-Induced Chondrogenesis (AMIC®) is a technique first developed in Germany and then pioneered in Switzerland in the early 2000s to help heal cartilage damage. It has some of the advantages of techniques such as autologous chondrocyte implantation, but avoids the lengthy and complicated in vitro culturing of cartilage cells (chondrocytes) and the requirement for a second surgical procedure.

The AMIC® method can be used in load-bearing joints, such as the ankle, knee and hip, and clinical studies have shown good results with significant improvement and success out to and beyond 10 years post-surgery. In combination with bone grafting, AMIC® can even be used in severe cases where a lesion may involve the subchondral bone to a considerable depth, such as osteochondritis dissecans (OCD).

Intended audience

This article is intended for anyone suffering from damage to their articular cartilage and their families who would like to find out about autologous matrix-induced chondrogenesis, as well as anyone interested in cartilage problems.

 

What is Autologous Matrix-Induced Chondrogenesis (AMIC®)?

AMIC® is a single-step surgery to repair deep chondral and subchondral lesions. If your surgeon considers that AMIC® is the correct treatment procedure for your injury, you will undergo surgery on your joint. This surgery is usually performed under general or spinal anaesthetic. AMIC® may be performed arthroscopically or in an open surgery.

During this surgery, your surgeon will remove the damaged cartilage. The bone will then be microfractured, or drilled, to encourage a controlled level of bleeding and to release MSCs from the bone and bone marrow. This step is called bone marrow stimulation.

If the surgery were to stop at this point, this approach would be standard microfracture. However, in AMIC®, a specially designed porcine collagen membrane, cut to fit perfectly within the prepared chondral defect, is placed over the bleeding bone surface. It is held in place with fibrin glue or is sutured around its periphery, depending upon surgeon preference, the intent of the repair, and the level of involvement of the subchondral bone.

Under the membrane a protected super clot containing MSCs then forms on the bone surface. This biological chamber, established by the presence of the membrane, helps the body to stimulate chondrocyte growth and is conducive to the regeneration of cartilage tissue.

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AMIC

What are the advantages and disadvantages of Autologous Matrix-Induced Chondrogenesis (AMIC®)?

What are the advantages of Autologous Matrix-Induced Chondrogenesis (AMIC®)?

  • AMIC® is a one-step procedure. There is no delay while cells are cultured in a laboratory, and no second operation is needed. The implant is naturally resorbed by the body.
  • AMIC® can be performed arthroscopically in many cases.
  • AMIC® is an established treatment with durable, long-term results. Patients who were treated up to 10 years ago are still benefitting from the treatment, with reduced pain and fewer symptoms compared with before the surgery.
  • Large defects which are not suitable for treatment with microfracture alone can be treated with AMIC®. Clinical studies have shown that AMIC® results in better outcomes than microfracture alone in large cartilage lesions.
  • AMIC® is a cost-effective treatment for repairing cartilage lesions.

What are the disadvantages of Autologous Matrix-Induced Chondrogenesis (AMIC®)?

AMIC® should not be used in patients with:

  • a known allergy to porcine collagen
  • acute or chronic infection at surgical site
  • acute or chronic inflammatory joint disease

Complications:

As with all surgical procedures, complications can occur during the AMIC® procedure.

Frequently Asked Questions (FAQs)

How long will the AMIC treatment last?

Studies have shown that patients who underwent AMIC® up to 10 years ago are still doing well.

When can I resume my normal activities?

The rehabilitation program is always customized by the physician, there are no general guidelines that can be applied to all patients. In many cases patients are able to begin partial weight bearing on the operated joint within a few days of surgery. Full weight bearing can be attempted after approximately 6 weeks. Activity should be increased gradually, and most patients should be able to resume sporting activities within 6 months.

Further reading

There have been a number of studies evaluating the outcomes of AMIC®. Some key papers are listed below:

  • Kaiser N, Jacobi M, Kusano T, Jakob R, Gautier E, Petek D. Clinical results 10 years after AMIC in the knee. Swiss Med Wkly 2015;145(Suppl. 219): FM145.
  • Kusano T, Jakob RP, Gautier E, Magnussen RA, Hoogewoud H, Jacobi M. Treatment of isolated chondral and osteochondral defects in the knee by autologous matrix-induced chondrogenesis. Knee Surg Sports Traumatol Arthrosc 2012;20:2109–15.
  • Lee YHD, Suzer F, Thermann H. Autologous matrix-induced chondrogenesis in the knee: A review. Cartilage 2014;5:145–53.
  • Wiewiorski M, Werner L, Paul J, Anderson AE, Barg A, Valderrabano V. Sports activity after reconstruction of osteochondral lesions of the talus with autologous spongiosa grafts and autologous matrix-induced chondrogenesis. Am J Sports Med 2016;44:2651–8.
  • Volz M, Schaumburger J, Frick H, Grifka J, Anders S. A randomized controlled trial demonstrating sustained benefit of autologous matrix-induced chondrogenesis over microfracture at five years. Int Orthop 2017;41:797–804.
Full-thickness cartilage damage, that…
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