Welcome to the ICRS Patient & Public Education Site

If you suffer from joint pain, you’re not alone. Each year, more than 50 million people visit their doctors because of joint pain — half of them with a damage of the articular cartilage.

On this website, you can find useful, updated information on specific cartilage-related conditions and possible treatments options, written by world-renowned experts in this field, helpful patient information to read and download, and other useful resources

The choice of procedures depends on the size and location of cartilage defect. Larger defects are typically treated with autologous chondrocyte transplantation, osteochondral allograft transplantation, or newer synthetic or natural scaffolds which may require open incisions. Smaller defects in specific locations may be treated with enhanced bone marrow stimulating techniques, autologous chondrocyte implantation (ACI), or osteochondral autograft transfer which may be completed through the arthroscope. There is also a chapter for conservative treatments options and rehabilitation after cartilage repair.

Intended Audience for this Website

People of all ages can suffer from cartilage complications, whether due to ‘wear and tear’ or injury. While the former is much more common in middle-aged patients, and even more so in women, injuries to the joints, such as trauma or accidents during active sports, can affect any age group or gender. Careers requiring repetitive or intense motion can increase the risk of developing cartilage problems, but there are several other risk factors, including age, weight and genetic predisposition.

What is Cartilage Repair?

On this website, we focus only on articular cartilage repair treatments, which means the restoration of damaged hyaline cartilage in the joints. Cartilage repair and regeneration is a treatment for joints that have damaged cartilage but are otherwise healthy. Typically, these procedures are recommended for cartilage damage or deterioration caused by:

Injury or trauma, including sports injuries or repetitive use of the joint Congenital abnormalities – abnormalities a person is born with (for instance misalignment) – that affect normal joint structure Hormonal or idiopathic disorders that affect bone and joint development, such as osteochondritis dissecans (OCD). There are several types of new and modern procedures for cartilage repair and regeneration techniques that are designed to heal the cartilage by filling the cartilage defect (pothole) with repair tissue.

What is not covered in this Website?

There are several types of bone and joint pain, each with many potential sources or etiologies. This site is not intended for people who suffers from rheumatoid arthritis (RA), gout, avascular necrosis (AVN), and cancer within bones, osteoporosis and other inflammatory or autoimmune diseases.

Acknowledgements

To the Mäxi Foundation: 
This website project would not have been possible without the substantial support of the Swiss “Mäxi Foundation”. The ICRS would like to express a deep gratitude for this very generous contribution to the International Cartilage Repair Society and the respective patient community, making it possible to provide updated information about cartilage damage and cartilage repair technologies free of charge to all interested persons.

To the Authors & Contributors:
The following world-renowned experts in cartilage repair & cartilage research have contributed to the extensive content of this website: Stephen Abelow (USA), William Bugbee (USA), Susan Chubinskaya (USA), Brian Cole (USA), Stefano Della Villa (IT), Chris Erggelet (CH), Jack Farr (USA), Ralph Gambardella (USA), Michael Gerhardt (USA), Wayne Gersoff (USA), Alan Getgood (CA), Alberto Gobbi (IT), Laszlo Hangody (HU), Oliver Kessler (CH), Elizaveta Kon (IT), Jos Malda (NL), Bert Mandelbaum (USA), Tom Minas (USA), Kai Mithoefer (USA), Stefan Nehrer (AT), Lars Peterson (SE), Scott Gillogly (USA), Holly Silvers (USA), Jason Theodosakis (USA) and Kenneth Zaslav (USA)

To anyone else who contributed to this important project
ICRS Office Staff, Medical Writers, Committees, Illustrators and Web Developers, etc.

Terms of Use

These terms of use, together with our Privacy Policy collectively, these “Terms of Use”, governs access to and any use of the website cartilage.org and any sub-sites (the “Website“), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree to bound and abide by the Terms of Use on behalf of all users of the respective computer. Visitors who do not agree with these Terms of Use must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) may revise and update these Terms of Use from time to time in our sole discretion. All changes are effective immediately when we post them. Your continued use of the Website following the posting of revised Terms of Use means that you accept and agree to the changes. You are expected to check this page from time to time so that you are aware of any changes, as they are binding on you.

The information on the Website is not intended to treat, diagnose, cure or prevent any cartilage related issues. Always seek the advice of a physician or other qualified health care provider with any questions you have regarding your medical condition.

Privacy Policy

This privacy policy (“Privacy Policy”), together with the Terms of Use for the patient website section, applies to any use of the website cartilage.org and any sub-sites (the “Website”), including any content, functionality and services offered on or through the Website. By using the Website or by clicking to accept or agree to the Terms of Use when that option is made available, visitors of the Website accept and agree on behalf of all users of the respective computer to be bound and abide by the Terms of Use and this Privacy Policy. Visitors who do not agree with the Terms of Use and this Privacy Policy must not access or use the Website.

International Cartilage Repair Society (“ICRS”) (“we” or “us”) is committed to protecting your privacy and ensuring that your personal information is protected. This Privacy Policy explains the types of personal information we collect and how we use, disclose and protect that information.

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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.
Keywords

AMIC, autologous matrix-induced chondrogenesis, Cartilage

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