"The local enrichment of these factors (higher concentration) to the defect significantly promotes the regeneration of the corresponding tissues. Since the platelets used remain active over a longer period of time, a single injection is sufficient to permanently initiate the healing of the tissue."
B. Bachelin Lausanne – Leading Opinions - Biologische Therapie von Knorpelschäden - Unsere klinische Erfahrung mit ACT und AMIC – Rheumatologie & Orthopädie 2011
The treatment of osteochondral defects with the help of biological procedures has been an integral part of the clinical therapy procedures within the Genolier Group since 2003. Since then, the globally established clinical procedures such as ACT (autologous chondrocyte transplantation) and AMIC (autologous matrix-induced chondrogenesis) have been successfully used at the Clinique de Montchoisi, the Clinique de Genolier and the Privatklinik Bethanien. Newer regenerative procedures developed within the last 8 years are presented below.
Platelet Rich Plasma
PRP (Platelet Rich Plasma) is a new biotherapeutic procedure especially for diseases of the tendons, ligaments, muscles and cartilage. PRP contains high concentrations of the body's own activated platelets, which produce regenerative growth factors and anti-inflammatory cytokines to heal damaged tissue.
In our clinical practice, PRP (RegenPRP, Regen Lab) is "made" from a small amount of the patient's blood (about 8cc) pre- or intraoperatively. The blood is centrifuged to obtain highly concentrated platelet-rich plasma, which can then be applied precisely to the damaged area. In the AMIC procedure, the matrix is placed in a dish with PRP concentrate for 5-10 minutes until it is saturated. The PRP activates the so-called mesenchymal stem cells, whereby the following healing-promoting growth factors are produced locally over a longer period of time:
PDGF = Platelet Derived Growth Factor
TGF Beta = Transforming Growth Factor Beta
VEGF = Vascular Endothelial Growth Factor
All of these factors are significantly involved in tissue repair processes. The local accumulation of these factors (higher concentration) at the defects significantly promotes the regeneration of the corresponding tissues. Since the platelets used remain active over a longer period of time, a single injection is sufficient to permanently initiate the healing of the tissue.
In 2003-20 10, a total of 48 patients (<50 years) were treated with ACT and 32 with AMIC. In 43 of the ACT cases and 27 of the AMIC cases (including 5 patella cases), an axis correction (HTO, open wedge, 37 varus, 6 valgus) was also performed at the same time.
Of a total of 70 cases (ACT + AMIC), 30 cases were followed up after 5 years. Of these, 25 cases are good to excellent, 4 cases satisfied with reduced sports activity and 1 case with no sports activity.
Over the last eight years, various surgical techniques have been developed for the treatment of cartilage lesions in the knee, ankle and hip, and new biological therapies such as the use of PRP (Platelet Rich Plasma) have been added to ACT and AMIC. These new regenerative treatments represent a real alternative to prosthetic joint replacement, especially for cartilage damage in younger patients who are seeking joint-preserving defect reconstruction, and also help to reduce costs.