For focal cartilage damage, especially in younger, active patients, restoring the joint surface can relieve pain and help delay or avoid a joint replacement. The technique is matched to the size and location of your defect.
Articular cartilage is the smooth surface that lets a joint glide. Unlike many tissues, it does not heal well on its own, and a focal defect can enlarge over time and lead to arthritis. Cartilage restoration aims to fill or replace the damaged area with living cartilage or a scaffold, protecting the rest of the joint. The goal is joint preservation, delaying or avoiding replacement.
Dr. Wichman offers a full range of cartilage procedures and selects among them based on the defect's size, depth, and location, and on your goals:
Cartilage procedures differ in how much high-quality data stands behind them. One of the best-studied newer options is CartiHeal Agili-C, a cell-free, aragonite-based implant that earned FDA approval in 2022. In its pivotal multicenter randomized controlled trial of 251 patients across 26 centers (Altschuler and colleagues, American Journal of Sports Medicine, 2023), Agili-C was compared head to head against the surgical standard of care, microfracture and debridement:
It can also be used when there is some surrounding osteoarthritis, which many cartilage procedures cannot. None of this means it is right for every defect; the best option still depends on the size, depth, and location of your cartilage damage, which we decide together.
Cartilage procedures protect the repair while it matures, so recovery is deliberate and often involves a period of limited weight-bearing and staged physical therapy. Timelines vary by procedure and defect. For one example protocol, see osteochondral allograft post-op instructions.
A group of joint-preserving procedures that repair or replace focal cartilage damage with living cartilage or a scaffold, aiming to relieve pain and delay or avoid joint replacement.
It depends on the size, depth, and location of the defect and your goals. Options range from microfracture for small defects to osteochondral allograft, MACI, DeNovo NT, or CartiHeal Agili-C for larger or deeper ones. We decide together after reviewing your imaging.
No. Restoration preserves your own joint by repairing a focal area of damage, most useful in younger, active patients. Replacement resurfaces a worn-out joint and is considered when arthritis is advanced.
Yes. In a 251-patient multicenter randomized controlled trial (American Journal of Sports Medicine, 2023), the Agili-C implant produced roughly double the knee-function improvement of microfracture and debridement at two years, with better cartilage fill on MRI (88.5% vs 30.9%) and a lower failure rate (7.2% vs 21.4%), and the advantage held out to five years. It is FDA-approved and can be used even with some surrounding arthritis. Whether it fits still depends on your specific defect.
New patients across Milwaukee are welcome. To request an appointment, email us at the address below and we will follow up to get you scheduled.
This page is for general education and is not medical advice. Whether a procedure is right for you is a decision made with your surgeon after an evaluation. If this is a medical emergency, call 911.
Wichman Orthopedics