title: Nanofractured autologous matrix induced chondrogenesis (NAMIC©)--Further development of collagen membrane aided chondrogenesis combined with subchondral needling: A technical note.
abstract: OBJECTIVE
  This technical note introduces a further development of the autologous matrix induced chondrogenesis (AMIC©) technology for regenerative surgery of cartilage defects considering latest data in the literature. The potential of subchondral mesenchymal stem cell stimulation for cartilage repair is combined with a membrane technique to enhance efficiency of cartilage regeneration. The nanofractured autologous matrixinduced chondrogenesis (NAMIC©) procedure is suitable for the knee, hip, ankle, shoulder and elbow joints.
  
  
  METHODS
  A standardized subchondral needling procedure (nanofracturing) is combined with fixation of a collagen I/III membrane to regenerate cartilage defects. Its advantages over microfracturing are smaller holes, deeper perforation into the subchondral space, a standardized procedure and earlier rehabilitation of the patient. The collagen membrane protects the blood clot forming after nanofracturing. The NAMIC© procedure may be performed arthroscopically alone, or in a combined arthroscopic setting with a mini-arthrotomy.
  
  
  RESULTS
  This is a further development of the AMIC© technology which allows earlier rehabilitation of the patient. The procedure is standardized. Early clinical results are encouraging. Nevertheless, caution is advised in the evaluation of this method as in that of any cartilage regenerating method.
  
  
  CONCLUSIONS
  The development of standardized subchondral regenerative procedures is important as only reliable clinical studies will give non-biased results. The NAMIC© procedure and the nanofracturing associated with it could be a promising step. As the rehabilitation period may be significantly shortened there is an earlier re-integration of the patient into the working life as compared to the AMIC© procedure.
  
  
  METHODS
  4.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Davos Hospital, Davos, Switzerland. Electronic address: jbenthien@spitaldavos.ch.
authors.forename: Jan P
authors.initials: JP
authors.lastname: Benthien
authors.affiliation: CUNO Orthopaedic Surgery, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Behrens
mesh_terms: D054544:Arthroplasty, Subchondral / Q000379:methods*; D002358:Cartilage, Articular / Q000293:injuries / Q000502:physiology / Q000601:surgery; D020219:Chondrogenesis; D024042:Collagen Type I; D024061:Collagen Type III; D015718:Fibrin Tissue Adhesive; D048091:Guided Tissue Regeneration / Q000379:methods; D006801:Humans; D008566:Membranes / Q000637:transplantation*; D054457:Tissue Scaffolds; D014182:Transplantation, Autologous
chemical_list: D024042:Collagen Type I; D024061:Collagen Type III; D015718:Fibrin Tissue Adhesive
keywords: AMIC©; Cartilage defect; Nanofracturing; Small holes; Subchondral needling