Cell-Free Aragonite-Based Scaffold With Bone Marrow Aspirate Concentrate Augmentation for Osteochondral Defects of the Knee.

BACKGROUND

Damage to the joint surface, which affects articular cartilage and the underlying subchondral bone, is a common cause for significant knee pain and disfunction. The use of CartiHeal Agili-C, a cell-free aragonite-based implant, is an emerging option for patients who may otherwise be a poor candidate for allograft transplantation or within geographic areas where there is a limited availability of donor tissue.

INDICATIONS

The CartiHeal Agili-C implant is indicated for patients with an International Cartilage Repair Society grade III or IV lesion with a total treatable area of 1 to 7 cm and without severe osteoarthritis.

TECHNIQUE DESCRIPTION

Standard parapatellar arthrotomy is performed to reveal an osteochondral defect of the femoral condyle. The cell-free aragonite-based scaffold is then transplanted in 7 steps according to numbered instrumentation in the Agili-C toolset. Surgical pearls of placement include proper alignment of the perpendicular aligner tool with circumferential viewing, assistant confirmation, and arthroscopic verification; avoiding wobbling during the shaping phase of the procedure as this may cause an oblong socket with inadequate fixation; and handling the implant with care and only using a thumb or index finger to insert with light tapping.

RESULTS

A multicenter randomized control trial followed 251 patients and found 88.5% of the implant group had at least 75% lesion fill as seen on postoperative magnetic resonance imaging at a 2-year follow-up. Additionally, patient-reported outcome measures were statistically superior when compared to controls at 24 months.

CONCLUSION

Transplantation of a cell-free aragonite-based scaffold (Aglili-C; CartiHeal Ltd), augmented with bone marrow aspirate concentrate, provides an efficient, reproducible surgical strategy in the management of osteochondral defects of the femoral condyles.

PATIENT CONSENT DISCLOSURE STATEMENT

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.