<unk>  (AMIC) surgery is a single step procedure. After arthroscopic evaluation of the cartilage damage and decision for an AMIC procedure a mini arthrotomy is performed. An all-arthroscopic AMIC procedure for repair of cartilage defects of the knee is also possible. First the cartilage defect is exposed and cleaned whereby all unstable degenerated cartilage, including the calcified cartilage layer, are carefully removed. An imprint of the defect is then taken using a sterile moldable material (e.g. aluminium foil) and transferred to the collagen membrane which is cut to shape. The surgeon then creates tiny holes/fractures in the subchondral bone plate (microfracturing) with a special awl. Blood and bone marrow (containing stem cells) are released forming a blood clot which contains cartilage forming elements. The correctly sized collagen membrane is added to the microfractured area either by fibrin glue<unk>  or commercially available) or suturing. Through flexion of the joint, the stable positioning of the membrane is verified and the wound is closed. An essential requirement for satisfying outcome of the AMIC surgery is the compliance to a strict physical therapy program. Guidelines and recommendations exist, though they have to be adapted to the individual patients needs.
Autologous matrix-induced chondrogenesis
Fibrochondrogenesis
Intramembranous ossification
Endochondral ossification
Autologous cultured chondrocytes on porcine collagen membrane
Fibrocartilage callus
Craterization
Demineralized freeze dried bone allograft