Autologous Cartilage Transplantation (ACI) is the gold standard in biological cartilage regeneration. It was NICE approved in 2017 but despite this there has been a low level of uptake in the UK and only a handful of NHS centres provide the procedure.

My NHS practice at University Hospital Southampton is one of the centres.

Biological scaffolds* have been around for 10 years plus and publications certainly seem to show superior outcomes to microfracture alone. Many types of materials are used as scaffolds, some are synthetic based while others are collagen based (derived from animals). They all have different physical properties but the aim is always the same:

TO INDUCE CHONDROGENESIS (FORMATION OF CARTILAGE) AND FILLE THE GAP IN THE CARTILAGE DEFECT

New Research

There is an exciting new area of research where human amniotic and umbilical cord derived products are being evaluated for use in tissue engineering. Amniotic membranes are currently licenced, and used, in the field of wound healing. Data is currently limited but certainly promising. We are currently in the process of evaluation this products for cartilage regeneration at Southampton.

The amniotic membrane (AM) is the innermost layer of the placenta and has a layer of epithelial cells which have similar properties to stem cells. Therefore, AM has been proposed as an ideal scaffold for chondrogenesis. AM has also been used in the field of Ophthalmology with promising results.

Over the next 2-3 years we should see more data available on the use of human placental products.

* The scaffolds themselves are not NICE approved and so availability on the NHS depends on whether the hospital will fund it themselves. On top of this most insurance companies will not authorise their use meaning it is then mainly available to the self-pay sector.

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