Combination of Cartiheal and Osteochondral Allograft for the Treatment of Multifocal Cartilage Defects

Multifocal cartilage defects about the knee have become increasingly prevalent. When left untreated, these injuries may progress to diffuse knee osteoarthritis. Operative management for patients with multifocal chondral defects typically includes partial or total knee arthroplasty. The senior authors (A.H.G. and S.M.S.) suggest the simultaneous use of osteochondral allograft (OCA) transplantation for patellar chondral defects and the Cartiheal Agili-C implant for trochlear chondral pathology as a viable option for patients with bipolar patellofemoral pathology.

Patients were indicated for the combined procedure presented in the clinic with symptomatic and functional difficulties with activities of daily living and sports. Magnetic resonance imaging evaluation demonstrated multiple chondral lesions. Patients failed nonoperative treatment measures, including a minimum of 3 months of formal physical therapy and injections.

A diagnostic arthroscopy was performed. An arthrotomy was performed, and, using the standard OCA technique, the patella was everted, and the recipient site was sequentially reamed. The OCA was prepared on the back table with a coring reamer using irrigation. A small K-wire was used to microperforate the bone. The allograft was irrigated with pulse lavage and CarboJet, soaked in bone marrow aspirate from the distal femur, and placed in the patellar defect with digital pressure. Attention was turned to the trochlea. Using the Cartiheal Agili-C technique, a threaded guide pin was drilled into the lesion, then drilled, and a hand reamer was used to achieve the appropriate depth. A shaper was used, and the edge was beveled, and the Cartiheal Agili-C implant was placed. This was repeated as necessary.

The literature suggests that OCA transplantation is an effective means for treating isolated articular cartilage defects in the knee. Cartiheal Agili-C implant is a novel and effective treatment for focal chondral defects, an alternative to OCA when graft availability is limited, or the defect is narrow or small. The combined use of OCA and Cartiheal Agili-C implants can address complex defect pathology and improve patient symptoms and function.

Full-thickness, multifocal chondral defects about the knee are difficult to treat. The combined use of Cartiheal Agili-C implant and OCA transplantation poses an innovative treatment option.

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