01 · Seed
NanoACi · Evidence by component
What supports each part of NanoACi?
Seed, Soil and Signal each have their own evidence base. This page shows the published research behind each one, how directly it applies to cartilage, and how Professor Lee combines them.
Reviewed byProfessor Paul Lee MBBch, FRCS (Tr & Orth), PhDCartilage and joint preservation expertiseQuick answer
NanoACi combines cartilage-derived micrografts, ChondroFiller and PRP in one injection session. Each part has human evidence: micrograft studies in knee chondropathy and osteoarthritis, ChondroFiller studies in articular cartilage defects, and randomised PRP trials in knee osteoarthritis. Outcomes for the combined technique are followed in the NanoACi 100 programme.
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A transparent evidence map
Three components. Three evidence questions.
Each part is assessed against the cartilage target. Evidence for one component is never presented as proof of the complete protocol.
02 · Soil
ChondroFiller
03 · Signal
Platelet-rich plasma
01 · Seed
Cartilage-derived micrografts
A small sample of the patient’s own auricular cartilage is processed on the day into micrografts containing cartilage-derived cells and native matrix.
How directly does the evidence apply?
This is the closest component evidence in the Nano family: human studies have examined auricular cartilage micrografts in knee chondropathy and osteoarthritis. They are the evidence for the Seed step.
Direct component evidenceEight-patient prospective case series; no comparator group.
Cartilage micrografts for knee chondropathy: three-year follow-up
Marcarelli M et al. Journal of Clinical Medicine. 2021;10(2):322.
Patient-reported quality of life and MRI cartilage thickness improved at three years in this small cohort.
Why it belongs here: Direct evidence for auricular cartilage micrografting in a cartilage target; not a study of NanoACi or its three-component combination.
Read the published sourceDirect component evidenceProspective observational study; no randomised comparator.
Non-arthroscopic autologous cartilage micrografts for knee osteoarthritis
Tsoukas D et al. Bioengineering. 2023;10(11):1294.
Pain and function improved after a single intra-articular application in early-to-moderate knee osteoarthritis.
Why it belongs here: Direct evidence for the cartilage-micrograft component, with the limitations of an uncontrolled observational study.
Read the published sourceDirect component evidenceEarly clinical pilot study.
Autologous micrografting for osteoarthritis pain
Helito CP et al. Bioengineering. 2024;11(11):1119.
The pilot reported improvements in osteoarthritis pain after autologous micrograft treatment.
Why it belongs here: Supportive early evidence for the micrografting step, but not definitive comparative evidence and not a test of NanoACi.
Read the published source02 · Soil
ChondroFiller® collagen scaffold
An injectable, cell-free type-I collagen matrix intended to provide a three-dimensional framework at the cartilage target.
How directly does the evidence apply?
ChondroFiller has product-specific clinical evidence in articular cartilage and laboratory evidence showing cellular activity within the matrix. That is the evidence for the Soil step.
Direct component evidenceProspective cohort; 21 of 26 patients available at 12–60 months.
Arthroscopic ChondroFiller gel for hip cartilage defects
Mazek J et al. Journal of Hip Preservation Surgery. 2021;8(1):87–93.
Seventeen of the 21 followed patients had good or excellent clinical results after treatment of acetabular cartilage lesions during hip arthroscopy.
Why it belongs here: Direct clinical evidence for ChondroFiller in articular cartilage, but in a surgical hip cohort without a control group.
Read the published sourceMechanistic evidenceLaboratory study using 61 human osteochondral explants.
Cell response within ChondroFiller in human osteochondral explants
Human ex-vivo osteochondral study. 2025. PMID: 41373902.
DNA content increased within the scaffold over 14 days, supporting cellular compatibility in an ex-vivo model.
Why it belongs here: Product-specific mechanistic evidence; it cannot predict a patient’s clinical outcome.
Read the published source03 · Signal
Autologous platelet-rich plasma
A platelet concentrate prepared from the patient’s own blood on the day, carrying platelet-derived growth factors to the treatment site.
How directly does the evidence apply?
PRP has randomised human trials in knee osteoarthritis, with placebo-controlled trials and pooled analyses showing better pain and function than saline or hyaluronic acid. The studies test PRP alone and differ in preparation and dose; in NanoACi, PRP is the Signal delivered alongside the cells and the scaffold.
Target-tissue evidenceProspective double-blind randomised placebo-controlled trial, 78 patients.
PRP is more effective than placebo for knee osteoarthritis
Patel S et al. American Journal of Sports Medicine. 2013;41(2):356–364.
A single or double PRP injection improved pain and function compared with saline, with the benefit maintained at six months.
Why it belongs here: Placebo-controlled human evidence that the patient’s own platelets improve symptoms in an osteoarthritic knee, the role PRP plays as the Signal.
Read the published sourceTarget-tissue evidenceRandomised double-blind placebo-controlled trial, 162 patients.
Multiple PRP injections outperform single injections and hyaluronic acid in early knee osteoarthritis
Görmeli G et al. Knee Surgery, Sports Traumatology, Arthroscopy. 2017;25(3):958–965.
Three PRP injections gave the greatest improvement in pain and function in early osteoarthritis, ahead of a single injection, hyaluronic acid and saline.
Why it belongs here: Human evidence that PRP improves early osteoarthritic knees and that dose matters; PRP alone, not the combination.
Read the published sourceIndirect evidenceMeta-analysis of ten randomised controlled trials, 1,069 patients.
PRP for knee osteoarthritis: meta-analysis of ten randomised trials
Dai WL et al. Arthroscopy. 2017;33(3):659–670.
At twelve months PRP gave better pain and function scores than hyaluronic acid or saline.
Why it belongs here: Pooled human evidence that intra-articular PRP improves pain and function in osteoarthritic knees.
Read the published sourceIndirect evidenceSystematic review and meta-analysis of 18 randomised controlled trials, 1,608 patients.
PRP versus hyaluronic acid: meta-analysis of randomised trials
Belk JW et al. American Journal of Sports Medicine. 2021;49(1):249–260.
PRP gave better pain and function scores than hyaluronic acid at follow-up, with the largest differences for leukocyte-poor preparations.
Why it belongs here: Pooled human evidence placing PRP ahead of hyaluronic acid, the standard injectable comparator, in knee osteoarthritis.
Read the published sourceThe combined protocol
Three established principles, one technique
NanoACi is Professor Lee’s non-operative clinical technique for combining these three point-of-care components. The component research is why these three were chosen; the combined protocol is being evaluated on its own outcomes.
Each component is used within its own evidence base. Professor Lee brings them together in one image-guided session, and outcomes for the complete technique are recorded at the clinic so that it is judged on its own results as well as on the evidence for its parts.
Questions about the NanoACi evidence
What evidence supports NanoACi?
Each component has human evidence. Auricular cartilage micrografts have been studied in knee chondropathy and osteoarthritis, ChondroFiller has published clinical use in articular cartilage defects, and PRP has randomised trials in knee osteoarthritis. NanoACi brings the three together in one session, and outcomes for the complete technique are recorded in the NanoACi 100 programme.
Which part has the most direct cartilage evidence?
The Seed and Soil have the closest target match. Auricular cartilage micrografts have been studied in human knee chondropathy and osteoarthritis, while ChondroFiller has been studied clinically in articular cartilage defects. Study designs and indications differ, which is why each study is labelled by how directly it applies.
What is the Signal in NanoACi?
The Signal is platelet-rich plasma, prepared from a small sample of your own blood on the day. PRP has randomised human trials in knee osteoarthritis and a broad evidence base in soft tissue. In NanoACi it is the Signal delivered alongside the cells and the scaffold.
Still have more specific concerns?
Free Discovery CallOptions that our doctors may discuss include NanoACi, ChondroFiller, Mytocel MSK, joint replacement, established conservative care or surgery, depending on examination and imaging.
Discuss the evidence, limitations and alternatives
Professor Lee can explain how the evidence applies to your cartilage, where the rationale is extrapolated and whether this pathway is proportionate.