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Author Topic: The only two technologies clinically demonstrated to regrow cartilage  (Read 244 times)

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Offline Robert Lloyd

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I know of only two technologies clinically proven to regrow cartilage in bone on bone arthritis.

They are:

1.  ACI/MACI (Carticel has been discontinued and replaced by MACI)
2.  Arthrex Autocart

Tigenix discontinued its product as far as I know.
https://www.evaluate.com/vantage/articles/news/after-us-approval-vericels-headache-begins

Dr. Stone makes a cartilage paste, but does it work as well as MACI and Autocart?

The following products are NOT clinically proven to regrow cartilage in bone on bone arthritis:
1.  Dr. Dunn's IAGH (I think this is a scam to be honest)
2.  Regenexx or any other mesenchymal stem cell product
3.  ACP/PRP
4.  So called umbilical cord stem cells (not only a scam, but dangerous and illegal)

Microfracture has been well demonstrated to regrow fibrocartilage (scar tissue).

So that's it--only two products on the market that I know of that regrow cartilage.  Are there any others?
« Last Edit: July 21, 2022, 01:35:27 AM by Robert Lloyd »

Offline gaoshanfelix

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This cartilage paste/paste graft seems to be very similar to minced cartilage (arthrex autocart). Arthrex autocart simply is more standardized and I would think has more research into it because it is used by a lot more doctors.
Essentially both mince the cartilage to about the same size and use Fibrin glue. There is a reason why it's called 2nd generation minced cartilage. I guess other big players could jump in and propose solutions too based on minced cartilage, but then those tools likely aren't much expensive and the centrifuge is the same as for prp or similar... Unlike aci/maci it's quite low tech.

Note that at least on the website some problems are still present with cartilage paste graft. By now it's clear that you should not use chondrocytes from non load bearing parts it possible due to lower quality. As long as you can with autocart it's recommended to just use the cartilage gathered while debriding/cleaning up the defect. It could be a the stone and co. Also adapted their techniques. I think the biggest pitfall is that they didn't think of a way to market it. So lack money for further research and the problems that arthrex solved by providing an easy to follow surgery method including all tools aren't solved. With autocart and I guess over 100 doctors using it by now much more feedback and data will have been gathered to further improve it. There are clearly differences now and Vs it's introduction 5-7 years ago. The principle is the same but it's refined. Essentially both is building up on much earlier minced cartilage trials.
« Last Edit: July 18, 2022, 12:12:35 PM by gaoshanfelix »

Offline gaoshanfelix

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Oh yes and microrafture/nanofractuere regrows some cartilage like substance. With amic they claim results are much better (so fracture plus scaffold) and it seems to be superior to no scaffold for sure.
There would need to be a comparative study Vs maci (in Europe i think currently only novocart inject plus still available/sold) and autocart.
Quite likely the financing will be hard to attain as there is no interest my Maci providers to finance such a study against much cheaper alternatives if they aren't sure it will come out clearly superior while it will be hard for a cheap solution to pay the maci costs... Amic Vs autocart on the other hand could be much more likely to be included in a blind study as costs are comparable (if you do a double blind study you can only charge patients with the costs of the cheapest treatment in the study).

Offline Robert Lloyd

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I updated my initial post to include microfracture as it does grow scar tissue.  Fibrocartilage is essentially scar tissue.

Offline gaoshanfelix

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I updated my initial post to include microfracture as it does grow scar tissue.  Fibrocartilage is essentially scar tissue.

Strangely somehow most meta studies do not sea a significant advantage of MACI over Microfracture - which however is likely due to the fact that microfracture isn't used on bigger damages anymore.
With AMIC some companies claim it grows hyaline cartilage in much more cases than 20% or similar (80% of people got fibrocartilage - while some actually did end up with mainly hyaline cartilage also after microfracture). Then of course it could be that those meta studies were done by health insurances/ advisory boards and designed to favor the much cheaper solution. I think in Europe many public health insurances stopped paying for MACI (while ACI is not available anymore for longer already) - so it's actually many people paying it out of their own pocket. Microfacture/AMIC however is more or less universally paid for by insurances. Autocart I think it depends on the country. Germany, Switzerland, Austria, Sweden --> paid for by public health insurance - UK as far as I know it's not covered (yet). Mind of course many people getting cartilage surgery are getting treatments at private hospitals instead of public ones - which still tend to sit it out and then have to cash out for partial or total knee replacement. I think the most popular AMIC product in Europe is Novocart basic.

For Amic/Novocart basic the following study should posts results in the next 2 years: https://clinicaltrials.gov/ct2/history/NCT03808623?V_3=View


Some other promising non snake oil future techniques: Fibrofix Cartilage by Orthox: https://www.bristol.ac.uk/news/2022/july/knee-implant.html
(if successful it will be available around 2030 - yep that shows you also how serious studies/products that aren't snake oil really take time to get through the study periods)

https://www.unibas.ch/en/News-Events/News/Uni-Research/Nasal-cartilage-relieves-osteoarthritis-in-the-knee.html#:~:text=Cartilage%20cells%20from%20the%20nasal%20septum%20can%20not%20only%20help,and%20even%20counteract%20the%20inflammation.


Also you forgot Denovo NT - minced juvenile allograft cartilage. It is only available in the US and also has proven regrowth of cartilage. It would be interesting to have a comparison study between Autocart and Denovo NT. Main advantage over Autocart is that you have Juvenile Donors, main disadvantages: much more expensive, unknown quality of the cartilage (is it load bearing or non load bearing cartilage - or a mix), not fresh. I kinda think Denovo NT has not proven it is superior to MACI and will never be a largely available product but only a niche product (maybe for older patients).


Another precursor of Autocart was CAIS: https://pubmed.ncbi.nlm.nih.gov/21460066/
respectively: https://www.briancolemd.com/wp-content/themes/ypo-theme/pdf/new-single-stage-cartilage-transplant-technique.pdf
(Brian Cole now seems to be a strong proponent of Autocart too). It was strongly superior to Microfracure at 12 and 24 months (sadly no 5 year data). With Brian Cole switching from CAIS to Autocart I guess CAIS is dead now.


A good overview of non snake oil techniques - but a bit outdated - is here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345961/

« Last Edit: July 18, 2022, 10:57:05 PM by gaoshanfelix »

Offline gaoshanfelix

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It's not actually regrowing cartilage - but in UK and USA OCA has become very popular too - meaning bone/cartilage from donors - it seems to be especially successful in the femoral condyle: https://www.uhcw.nhs.uk/download/clientfiles/files/Patient%20Information%20Leaflets/Trauma%20and%20Neuro%20services/Trauma%20and%20Orthopaedics/Knee%20Reconstruction%20-%20Osteochondral%20Allografts%20(2192).pdf
https://www.briancolemd.com/wp-content/themes/ypo-theme/pdf/treatment-approach-to-cartilage-defects2016.pdf

OATS hasn't been mentioned either - it is the same as OCA but limited in size as the plug will be taken from non load bearing location.

The advantage is the fastest recovery more or less of any kind of cartilage surgery.

Offline Brandon123

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Nice overview, thanks! From a consumer/patient perspective, the "cartilage repair/regrowth" industry is certainly messy. 
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline Dave33

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Nice overview, thanks! From a consumer/patient perspective, the "cartilage repair/regrowth" industry is certainly messy.

Definitely. And also generally have "ok-ish" results on focal lesions, a younger cohort, and areas of the knee where there's less load and shearing (ie-not patella) And a huge reason why needle based treatments look so much more attractive, and are so much easier to market despite sketchy science.

There really aren't any good answers available. Just things that can be tried that have more science and patient commitment behind them than others.

Offline Robert Lloyd

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Also you forgot Denovo NT - minced juvenile allograft cartilage. It is only available in the US and also has proven regrowth of cartilage. It would be interesting to have a comparison study between Autocart and Denovo NT. Main advantage over Autocart is that you have Juvenile Donors, main disadvantages: much more expensive, unknown quality of the cartilage (is it load bearing or non load bearing cartilage - or a mix), not fresh. I kinda think Denovo NT has not proven it is superior to MACI and will never be a largely available product but only a niche product (maybe for older patients).

Interesting.  I'd never heard of Denovo.  If I were an 80 year old patient I'd absolutely think I should try this first over my own really old cells. 
The problem is I can't get honest answers from the vast majority of surgeons.  They only will discuss the products they sell.

Quote
(Brian Cole now seems to be a strong proponent of Autocart too). It was strongly superior to Microfracure at 12 and 24 months (sadly no 5 year data). With Brian Cole switching from CAIS to Autocart I guess CAIS is dead now.

Brian Cole is referenced a lot in the cartilage world.  He seems to be a major player in the cartilage regeneration medical arena.

Offline gaoshanfelix

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BTW - the most positive study ever for MACI I have found is this one: https://www.frontiersin.org/articles/10.3389/fbioe.2021.760179/full
I would not trust it much though. Too small group, too much pressure in China to provide positive results and it's really hard to believe there was already 3 month post OP a significant improvement in all KOOS scores.
This is contrary to the experience of nearly everyone on here and most literature in which most people are worse of 3 month post surgery - and usually around the 6 month mark slowly get back to pre surgery activities.
Hence I would not trust their MOCART scores either - too positive.















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