01 · Seed
NanoACi · Evidence by component
What supports each part of NanoACi?
Seed, Soil and Signal each have a different evidence base. This page shows the relevant research, how directly it applies to cartilage and where Professor Lee’s combined technique remains an evidence-led clinical rationale rather than a proven protocol.
Reviewed byProfessor Paul Lee MBBch, FRCS (Tr & Orth), PhDCartilage and joint preservation expertiseQuick answer
NanoACi combines cartilage-derived micrografts, ChondroFiller and ArthroZheal PRF. There is relevant evidence for each part, especially the cartilage-matched Seed and Soil, but there is not yet a comparative clinical trial of the complete named combination.
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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
ArthroZheal PRF
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 support the Seed step, not the full NanoACi combination.
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 evidence belongs to ChondroFiller; it does not establish the outcome of adding micrografts and ArthroZheal.
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
ArthroZheal® platelet-rich fibrin
An autologous platelet-rich fibrin preparation made from the patient’s blood, providing a fibrin matrix and platelet-derived biological signals.
How directly does the evidence apply?
The exact Vivostat PRF platform behind ArthroZheal has laboratory evidence on growth-factor delivery and an observational knee osteoarthritis study. This is component evidence; it is not proof that the full NanoACi protocol regenerates cartilage.
Mechanistic evidenceIn-vitro study using human dermal fibroblasts.
Bioactivity and stability of a platelet-rich fibrin product
Lundquist R et al. Wound Repair and Regeneration. 2008;16(3):356–363.
Vivostat PRF supported fibroblast proliferation and type-I collagen synthesis and protected growth factors within its fibrin matrix.
Why it belongs here: Exact-platform mechanistic evidence, but not cartilage clinical outcome evidence.
Read the published sourceMechanistic evidenceLaboratory characterisation study.
Growth-factor and proteinase profile of Vivostat PRF
Agrén MS et al. Vox Sanguinis. 2014;107(1):37–45.
The study characterised platelet enrichment, growth factors and proteinases in the preparation.
Why it belongs here: Explains what the product contains; it does not demonstrate a cartilage treatment effect.
Read the published sourceThe combined protocol
Clinical innovation, with the evidence boundary kept visible
NanoACi is Professor Lee’s non-operative clinical technique for combining these three point-of-care components. The component research makes the selection biologically and clinically reasoned; it does not remove the need to evaluate the combined protocol on its own outcomes.
Progress sometimes begins by bringing established biological principles together before the combination has a mature evidence base of its own. Years of research, operating experience and familiarity with the component parts provide a serious basis for innovation. They are also the reason to state the remaining uncertainty precisely, rather than hide it behind a broad claim.
Questions about the NanoACi evidence
Has the complete NanoACi protocol been proven in a comparative trial?
Not yet. There is human evidence for auricular cartilage micrografts and product-specific cartilage evidence for ChondroFiller, plus mechanistic and observational evidence for the Vivostat PRF platform behind ArthroZheal. Those bodies of evidence support the rationale for the components, but do not prove the named three-part protocol.
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, so neither should be read as a trial of NanoACi.
Why use ArthroZheal rather than describing the Signal as generic PRF?
The component used in the pathway is ArthroZheal, based on the Vivostat PRF system, so its exact identity matters. Published laboratory studies characterise its fibrin matrix and biological signals. That is not the same as proof of a cartilage-regeneration outcome.
Are Professor Lee’s statements published evidence?
No. They are clearly labelled draft expert rationale: an explanation of why Professor Lee has selected the components based on their biology, available evidence and clinical experience. The statements require his approval before publication and must remain separate from the study summaries.
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.