What One NanoACi Sitting Includes

One sitting, one room, one procedural arc

The question most patients carry into a first consultation is a practical one: how much of this involves an operation? For NanoACi — Professor Paul Lee's surgeon-led, non-arthroscopic, needle-delivered, one-stage autologous chondrogenic injection technique — the answer is that every step, from tissue sampling to final delivery, takes place in a single clinic room in approximately half an hour. The patient remains awake throughout, under local anaesthetic only. There is no operating theatre, no general anaesthetic, and no offsite laboratory involvement at any point in the session.

That single visit is the treatment in full. Where conventional autologous chondrocyte implantation (ACI) requires two separate hospital admissions, two anaesthetics, and weeks of laboratory cell culture between them, NanoACi completes an equivalent biological intent without a second procedure.

The sitting is not, however, the whole pathway. Case selection, imaging review and a specialist assessment come before it; surgeon-led follow-up comes after. What the sections below describe is the procedural arc of the sitting itself — the sequence of steps that unfolds once the patient is in the room.

First step: autologous blood draw and PRF preparation

Blood draw is the sitting's opening move. As the patient settles, a sample of their own blood is taken and placed immediately into a sealed automated system that processes it, within the same room, into platelet-rich fibrin (PRF). No external laboratory is involved; the material never leaves the clinic.

PRF is the signal component of NanoACi — autologous by definition, because it is derived entirely from the patient's own blood with no donor material and no synthetic additive. Suspended within its fibrin matrix are platelets and the growth factors they carry, designed to act as a sustained biological instruction source at the repair site.

Because processing runs in parallel with the tissue harvest and preparation steps that follow, PRF is ready by the time the other components are assembled. It contributes nothing to overall session length. This concurrency is deliberate: the sitting is engineered so that no step waits on another.

Where the cartilage comes from: the ear punch biopsy

Three small punch biopsies — each 2.5 mm across — taken from the concha of the ear under local anaesthetic are all that the tissue harvest step requires. The patient is awake; the ear is numbed, the punches are taken, and the donor site is dressed. The concha heals within approximately one week, and the marks sit concealed within the natural fold of the ear, where they are not visible in everyday life.

The ear is used because of where these cells come from biologically, not because it is accessible. Auricular cartilage originates from the neural crest rather than the mesoderm — the embryological layer that gives rise to most of the body's musculoskeletal tissue. Neural-crest cells are HOX-negative, meaning they carry no fixed positional identity, and published research suggests this developmental flexibility allows transplanted auricular cartilage cells to read a joint environment and adapt accordingly.

These biopsies become the seed component of the sitting's three-part preparation: the autologous source of chondrogenic cells. No general anaesthetic is needed at this stage, no arthroscopic access, and no secondary surgical incision. The punches pass directly to mechanical preparation at the point of care — the next step in the procedural arc.

Preparing the micrografts: mechanical, not enzymatic

The three ear punch biopsies pass directly to mechanical mincing — a point-of-care step that converts them into autologous micrografts without any enzymatic digestion. No chemical agent breaks down the tissue; the preparation is entirely mechanical, completed in the clinic room within the same sitting.

That distinction matters structurally. In ACI and MACI, enzymatic digestion is used to isolate individual chondrocytes from harvested cartilage — a laboratory process that then requires weeks of cell culture to expand those cells to implantable numbers. NanoACi's mechanical approach bypasses both steps. The tissue is minced rather than dissolved, cells are retained within their native matrix, and no expansion interval follows.

The third component — the cell-free native type I collagen matrix that serves the scaffold role — does not require preparation within the sitting. It is a manufactured, ready-to-use matrix, brought to combination at point of care without modification. This is not a gap in the process; it is the nature of the component. Component evidence spanning more than a decade of multi-joint clinical use suggests the scaffold is designed to provide the structural environment that retains the micrografts at the repair site, though outcomes for the exact three-part combined protocol are being evaluated through the NanoACi 100 prospective programme.

With micrografts prepared and all three components assembled in the room, the arc moves to combination and delivery.

Combining the three components and delivering into the joint

The combination step brings all three components together into a single preparation at point of care. Each addresses a distinct reason joints fail to self-repair: the micrografts supply chondrogenic cells (seed); the collagen matrix anchors those cells at the lesion site (scaffold); and the PRF delivers the biological instruction signal through sustained growth-factor release (signal). Delivered separately, each element is insufficient — cells wash away without a structural anchor, the scaffold cannot rebuild without cells, and growth factors have nothing to direct. Combined into one preparation, the three constitute an integrated biological case for repair rather than three parallel interventions.

Delivery is the closing step. The specialist administers the combined preparation through a needle directly into the target joint. No arthroscope is involved; no operating theatre is required. The needle is the access route, not the treatment: what defines the procedure is the specialist's full sequence of imaging review, case selection, tissue preparation, sequenced assembly and controlled delivery — not the instrument used at the end of it.

Once the needle is withdrawn, the sitting is complete. The patient is not admitted. No second procedure follows; no return visit to a laboratory, a theatre or an inpatient ward is needed. The procedural arc that opened with blood draw closes at point of care, in the same clinic room where it began.

The sitting in context: what comes before and after

The half-hour arc described here sits within a longer specialist pathway that begins before the clinic room and continues after it. Case selection, imaging review and symptom assessment all precede the sitting; mechanical alignment, joint instability, diagnosis and the patient's own treatment goals may each affect suitability. The sitting is the treatment-execution phase of that pathway — precisely defined, but reached only after specialist assessment has confirmed it is the appropriate route for a given joint.

Surgeon-led involvement does not end when the needle is withdrawn. Follow-up and outcome monitoring are integral to the process; what happens in the clinic room is a step within a structured specialist programme, not the whole of it.

On the evidence: published data support each component individually — the collagen scaffold carries more than a decade of multi-joint trial use, and PRF is an established sustained growth-factor source — but outcomes for the exact three-part combined NanoACi protocol are being evaluated prospectively through NanoACi 100, the programme tracking the first 100 consecutive cases. Component evidence and combined-protocol evidence remain distinct categories, and that distinction is worth holding clearly.

What the sitting ultimately demonstrates is that the entire biological case for cartilage repair — tissue, matrix, growth factors — can be assembled in one room, at one moment, without a laboratory or a second procedure between them. Whether that approach is right for a particular patient and a particular joint is a clinical determination; a consultation or imaging review with a specialist is where that question properly begins.