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 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.