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Ethics declarations Funding This study was conducted as part of the authors regular employment duties at the French National Health Insurance (CNAM), the French National Agency for Medicines, and Health Products Safety (ANSM)

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Specifically, to simulate the in vitro expansion for ACI, human chondrocytes were expanded to a population doubling level (PDL) 9 to represent chondrocytes ready for implantation

Patients should maintain adequate hydration, especially if experiencing gastrointestinal side effects, to reduce the risk of acute kidney injury

Ongoing monitoring ensures early identification of any adverse reactions

Fagher B, Thysell H, Nilsson-Ehle P et al (1982) The effect of D, L-carnitine supplementation on muscle metabolism, neuropathy, cardiac and hepatic function in hemodialysis patients