01 · Seed
NanoATi · Evidence by component
What supports each part of NanoATi?
NanoATi starts with an autologous fibroblast-rich Seed, then adds collagen support and an autologous signal. The biological logic is coherent, but the direct clinical evidence is limited and mixed, so every step is labelled precisely.
Reviewed byProfessor Paul Lee MBBch, FRCS (Tr & Orth), PhDCartilage and joint preservation expertiseQuick answer
There is no direct human trial of the complete NanoATi protocol or its fibroblast-rich micrograft Seed. The collagen and platelet-rich-fibrin choices have a biological rationale and related research, but much of that evidence is indirect—and exact-platform tendon evidence includes a negative randomised pilot.
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A transparent evidence map
Three components. Three evidence questions.
Each part is assessed against the tendon target. Evidence for one component is never presented as proof of the complete protocol.
02 · Soil
Type-I collagen scaffold
03 · Signal
Platelet-rich fibrin
01 · Seed
Autologous fibroblast-rich micrografts
A small hair-follicle-bearing tissue sample is mechanically processed on the day into an autologous micrograft suspension containing fibroblast-rich dermal tissue and native matrix.
How directly does the evidence apply?
Hair-follicle-derived mesenchymal cells have been studied in a rabbit Achilles model and hair-follicle dermal precursors show multi-lineage plasticity in laboratory research. This is preclinical support for the donor-tissue rationale—not evidence that chair-side micrografts deliver the same cells, dose or outcome in human NanoATi.
Preclinical evidenceRabbit Achilles tendinopathy study using cultured hair-follicle-derived cells.
Hair-follicle-derived mesenchymal cells in Achilles tendinopathy
Ma Y et al. Chinese Medical Journal. 2023;136(9):1089–1097.
The treated tendons showed improved biomechanical and collagen measures in this preclinical model.
Why it belongs here: Relevant to the hair-follicle donor concept and tendon target, but it used cultured cells in animals—not mechanically processed micrografts in people.
Read the published sourceMechanistic evidenceLineage-tracing and laboratory study.
Hair-follicle dermal precursors show neural-crest-like properties
Jinno H et al. Stem Cells. 2010;28(11):2027–2040.
Follicle-associated dermal precursors from different body sites had distinct origins but shared neural-crest-like and multi-lineage properties.
Why it belongs here: Supports donor-niche plasticity while showing why “all hair-follicle cells come from neural crest” would be inaccurate.
Read the published source02 · Soil
Injectable type-I collagen scaffold
A three-dimensional type-I collagen framework used to support local retention and organisation around the delivered micrografts.
How directly does the evidence apply?
Tendon is predominantly type-I collagen. A small human pilot combined tendon-derived cells with a different type-I collagen scaffold during rotator cuff repair. Professor Lee currently selects ChondroFiller as the injectable Soil, but its published product evidence is in cartilage, not tendon.
Indirect evidenceSmall clinical pilot involving 18 surgical patients.
Tendon-derived cells with a type-I collagen scaffold in rotator cuff repair
Human pilot study. 2022. PMID: 34976729.
The study explored tendon-derived cells carried on a type-I collagen scaffold during rotator cuff repair.
Why it belongs here: Biologically relevant but indirect: a different scaffold, a surgical procedure and a different cell-processing pathway.
Read the published source03 · Signal
Autologous platelet-rich fibrin
An autologous fibrin and platelet preparation used to provide a local matrix and platelet-derived biological signals.
How directly does the evidence apply?
The Vivostat PRF system selected by Professor Lee has been tested in tendon surgery, but the randomised rotator-cuff pilot did not show improvement. This exact-platform evidence is important precisely because it is not positive, and it cannot support a promise for NanoATi.
Mixed evidenceRandomised pilot study involving 28 patients.
Vivostat PRF during massive rotator cuff repair
Antuña S et al. Acta Orthopaedica Belgica. 2013;79(1):25–30.
The study did not show better clinical or structural outcomes with PRF; retears occurred in both groups.
Why it belongs here: Exact-platform tendon evidence, but as an adjunct to surgery rather than non-operative NanoATi—and the result was negative.
Read the paper (PDF)Mixed evidenceRandomised controlled trial involving 79 patients.
Platelet-rich fibrin matrix in rotator cuff repair
Rodeo SA et al. American Journal of Sports Medicine. 2012;40(6):1234–1241.
The platelet-rich fibrin matrix did not improve tendon-to-bone healing or clinical outcomes.
Why it belongs here: Relevant caution from another PRF preparation; it does not directly test ArthroZheal or NanoATi.
Read the published sourceThe combined protocol
Clinical innovation, with the evidence boundary kept visible
NanoATi is Professor Lee’s clinician-developed technique for combining fibroblast-rich micrografts, collagen support and an autologous signal. In its standard form it is delivered percutaneously without an operation. The protocol should be evaluated through its own prospectively recorded outcomes rather than borrowing certainty from adjacent studies.
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 NanoATi evidence
Is there direct human evidence for the NanoATi Seed?
We did not locate a human clinical trial of hair-follicle-derived, fibroblast-rich micrografts prepared and delivered as the NanoATi Seed. There is a rabbit Achilles study using cultured hair-follicle-derived cells, but that does not prove the chair-side human protocol.
Why use a type-I collagen scaffold in tendon?
The rationale is that tendon is predominantly type-I collagen and ChondroFiller provides an injectable type-I collagen framework. That is an extrapolation from biology and from other scaffold research: ChondroFiller’s published clinical product evidence is in cartilage, not tendon.
What does the ArthroZheal tendon evidence show?
The exact Vivostat PRF platform has been assessed during rotator cuff surgery, but a small randomised pilot did not demonstrate improved outcomes. That negative result is shown because a balanced evidence page must include evidence that does not support benefit.
Does the biological injection replace tendon rehabilitation?
No. Progressive mechanical loading remains central to tendon recovery. The loading plan is part of the pathway and the clinical outcome should be judged by strength, function and task tolerance as well as symptoms.
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 tendon, where the rationale is extrapolated and whether this pathway is proportionate.