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Author Topic: Microfracture vs. Autologous Matrix Induced Chondrogenesis (AMIC)  (Read 4435 times)

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Offline WestPoint

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I was just wondering if anyone has any understanding of how Autologous Matrix-Induced Chondrogenesis (AMIC) is superior to regular microfracture. The company indirectly claims that it produces a more hyaline-like cartilage than simple microfracture (even this claim is not overt, as you can see in the passage below). If this is really true, the fact that it only requires a single operation certainly sounds advantageous. However, it seems to me that the information and explanation of how it doesn’t just produce fibrocartilage is not clear to me at all:

Autologous Matrix Induced Chondrogenesis (AMIC)

The AMIC® technique is new biological cartilage repair method. This innovative technique uses the body’s own healing potential and the regenerative capacity of mesenchymal stem cells. It can be applied to full thickness cartilage defects that extend down to the subchondral bone and are bigger than 1 to 2 cm2.The AMIC® technique is based on proven biological concepts first demonstrated by Dr Richard Steadman with his microfracture method. The shortcoming with microfracture is that it only appears to be able to regenerate fibrocartilage and not hyaline cartilage which is much stiffer and more resistant to shear forces. AMIC® differs from microfracture in that a cover, in the form of the Chondro-Gide® collagen matrix, is applied over the defect immediately following microfracture (the subchondral bone plate is penetrated using a sharp awl or microfracture pick approximately 4 to 5 mm apart). The Chondro-Gide®matrix can be fixed with fibrin glue, sutures or resorbable pins. This cover then traps the first few millilitres of bone marrow bleeding which contain the highest percentage of mesenchymal stem cells to form a so called ‘Superclot’. In so doing the first and most important clot is kept in place and not lost into the joint which appears to happen with microfracture. The Chondro-Gide® collagen matrix forms the roof of a ‘biological chamber’ and serves to protect and contain the stem cells as they differentiate into chondrocytes, which will form a healthy regenerative cartilage. Source: Geistlich Surgery.

Offline Lottiefox

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Re: Microfracture vs. Autologous Matrix Induced Chondrogenesis (AMIC)
« Reply #1 on: June 04, 2010, 10:49:45 PM »
It is a similar theory to Cartifill in that it is a collagen based "top coat" applied over the released stem cells generated by MFX. At least it sounds that way to me. It differs slightly in that it discusses using pins etc to stick it in place. Cartifill bonds as it sets from my understanding. I guess the benefit of any of these advanced MFX technqiues is that they are one procedure and can usually be done via scope. They remove the need for two ops, for open surgery and therefore reduce the risks of infection, scarring in the joint and so on. Many ACI/MACI patients need a third surgery to deal with overgrowth - ironically you can end up with too much lovely new cartilage!  ::)

Is AMIC available worldwide?

Its a tricky one when you try to decide on cartilage repair. It often seems the more you read, the harder the choice is.  ???

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline WestPoint

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Re: Microfracture vs. Autologous Matrix Induced Chondrogenesis (AMIC)
« Reply #2 on: June 05, 2010, 09:35:13 AM »
I agree with you that the more you read, the harder the choice is. I too would much rather a one operation procedure, and would go for either Cartifill or Amic if I knew that it would last. But I just don't understand how it can produce hyaline-line cartilage while the essence of the procedure is microfracture. From what I know, microfracture does not usually stand up to the pressures of weight bearing and everyday life in the long run. Even the company's claims are difficult to understand and seem to be somewhat unsupported (at least at this point).

Lottie, does Dr. Shetty address the issue of fibrocartilage when talking about Cartifill?

I figure we could contact AMIC and ask them where it's being used in the U.K.. I took that paragraph from the Chester Knee Clinic website. Perhaps they use it there?

Offline mmrocker13

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Re: Microfracture vs. Autologous Matrix Induced Chondrogenesis (AMIC)
« Reply #3 on: June 05, 2010, 05:08:39 PM »
Long term studies are starting to suggest that ACI-type procedures really don't produce any "better" cartilage substitutes than the fibrocartilage in MFX. Personally, I would always elect to do the MFX first, as it is a far less invasive procedure.
89: Pat. dislocation, lat. meniscus tear, femoral OCD lesion
89: debridement, chondroplasty, lateral partial menisectomy
02: partial lat. menisc., debride
02: mfx
09: subtotal menisc., debride, c'plasty
10: scope/debride
10: varus DFO
13: HWR
15: total menisc., debride, c'plasty, notchplasty

Offline Lottiefox

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Re: Microfracture vs. Autologous Matrix Induced Chondrogenesis (AMIC)
« Reply #4 on: June 05, 2010, 05:53:17 PM »
AMIC does look interesting, I assume Chester might be using it if they are discussing it. The OS there is well known in cartilage repair. Mr Shetty has simple said that the cartifill process produces a repair that is more robust than simple MFX but I haven't pushed him on the hyaline quality. I have to say that one procedure and a shorter rehab appeals to me as a first line attack. Even on a WB area (as my medial lesion is) I would probably give it a go, as I am sure the rest of my knee will continue to degenerate and if i went with ACI I may never reap the true benefits. But - my conditions are slightly different to an isolated traumatic lesion, although the grade 4 MFC lesion IS traumatic in its nature. Unfortunately it now sits amongst other generally wearing out cartilage! Shetty is also discussing stem cell therapy that will resemble the Regenexx direct injection approach, but this is some way off. I saw photos of hyaline-like cartilage regenerated in sheep using this approach that he has developed.

I think what worries me about all of these repairs is the trade off between what you have now and what you might have. My WB lesion doesn't bother me in normal walking. It doesn't swell, doesn't throb. BUT if I catch it wrong on something like going down a step it is exquisitely painful and that means I am usually guarding against the wrong angle. My spontaneity of knee motion has reduced a lot. The kneecap lesions are achy when they flare up, but they are helped a LOT by the right exercises and not doing daft things like lunges!

I forgot to say that there is a big cartilage conference going on in London this Autumn and Mr Shetty said I could go along as an "interested" observer. I need to pin him down as to the logistics but they be will discussing new techniques and doing live cadaver surgery (or dead surgery if thats a better way of putting it). Seeing as I've become a bit of a geek about all of this I may well go along and see whats happening if I can get in!

Cartilage repair - it is not an easy science... :-\
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline thevoice

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Re: Microfracture vs. Autologous Matrix Induced Chondrogenesis (AMIC)
« Reply #5 on: June 05, 2010, 06:05:59 PM »
AMIC is done by quite a few hospitals within the UK - its also part of the ACTIVE study. Many class it as a rich mans Microfracture but a poor mans MACI. It was devloped to provide people with a inbetween step between MFX and MACI as some health companies wouldnt pay for MACI due to needing longer term studies (it came down to cost end of the day).

ACI though has produced excellent 20 year data and MACI (it hasnt been used long enough to reach the 20yr mark) should do the same as in year by year there both quite close with MACI having the slight better outcome normally.

Offline WestPoint

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Re: Microfracture vs. Autologous Matrix Induced Chondrogenesis (AMIC)
« Reply #6 on: June 05, 2010, 06:26:13 PM »
Interesting post Lottie…

I agree with you that Cartifill and Amic make interesting first line choices, and if I knew more about the details of the ‘robustness,’ it would make it easier for me to do. However, I’m going to sell my car to do this operation, and would prefer to do it just once but properly. My fear in doing Cartifill or Amic is that I eventually end up like all those other people who tried microfracture and failed. What is the success rate of microfracture anyway? ACI and MACI seem to have better proven results, although of course, the 70-80+% success rate is not perfect either.

I’m still suffering a lot from muscle wastage. I’m only doing some exercises on the bike with leg raises and a few of the exercises they say you should do directly after the operation (I’m three months + post op. now). I have trouble walking around at work, and use the time to rest my leg when I get home. I find it hard to do any other exercises when the mechanics of the knee are not good.

The Regenexx type treatments sound interesting but so much research needs to be done in this area. Like you said, cartilage repair is not an easy science.

The Voice, just saw your post. Do you know of any hospitals in particular? Also, I think the key to understanding AMIC and Cartifill or anything similar, is to try to find out how much more hyaline-like it is than regular microfracture. It seems that nobody is able to give us a clear answer on this, or point us to any studies on the subject.

Offline WestPoint

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Re: Microfracture vs. Autologous Matrix Induced Chondrogenesis (AMIC)
« Reply #7 on: June 07, 2010, 04:27:50 PM »
I found the following information:

http://www.kneejointsurgery.com/html/articular_cartilage/microfracture.html

Autologous Membrane Induced Chondrogenesis (AMIC)

This is one stage technique of microfracture with augmentation where a collagen membrane is implanted over a chondral defect that has been treated by microfracture technique. It is not clear whether this is likely to produce superior repair tissue but the technique may be useful in treating a large lesion with microfracture.

Breinan showed that use of a Type II collagen membrane to cover a defect after treatment with microfracture created superior tissue fill though the tissue was still predominantly fibrocartilage. Kramer (2006) reported that mesenchymal stem (MS) cells can in fact be recovered from matrix material saturated with cells from bone marrow after microfracture. This introduces a new technique for MS cell isolation during arthroscopic treatment.

However Dorotka showed that although the collagen matrix is an adequate environment for BMSC in vitro, the additionally implanted unseeded collagen matrix did not increase the repair response after microfracture in chondral defects. They showed the benefit of adding autologous cultured chondrocytes.

Breinan H.A., Hu-Ping Hsu, Martin S, and Spector M, Healing of canine articular cartilage defects treated with microfracture, a typeII collagen matrix, or cultured autologous chondrocytes; J Orthop Research 2000, 18,781

Kramer J, Bohrnsen F, Lindner U, Behrens P, Schlenke P, Rohwedel J In vivo matrix-guided human mesenchymal stem cells. Cell Mol Life Sci. 2006 Mar;63(5):616-26

Dorotka R, Windberger U, Macfelda K, Bindreiter U, Toma C, Nehrer S. Repair of articular cartilage defects treated by microfracture and a three-dimensional collagen matrix. Biomaterials. 2005 Jun;26(17):3617-29

Offline IMF73

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Re: Microfracture vs. Autologous Matrix Induced Chondrogenesis (AMIC)
« Reply #8 on: December 14, 2015, 10:50:12 PM »
Hi @Lottiefox I realise this is an old thread but are you still active on this forum?
I have recently had knee surgery by Mr Shetty and would be keen to ask you a few questions.
Did you have surgery by him ?