Surgical Technique for Treating Focal Osteochondral Knee Lesions Using an Aragonite-Based Biphasic Scaffold

Osteochondral lesions of the knee, particularly in patients with early osteoarthritic changes, remain a clinical challenge. The Agili-C implant (CartiHeal, Smith & Nephew), an aragonite-based osteochondral scaffold, offers a single-stage, off-the-shelf solution designed to regenerate both cartilage and subchondral bone. Unlike cell-based therapies, Agili-C eliminates the need for cell harvesting, culturing, or bioreactors, and avoids the morbidity associated with autografts and allografts. Recent multicenter randomized controlled trials have showed superior functional outcomes and pain reduction with Agili-C compared to microfracture and debridement, even in patients with early osteoarthritis (Kellgren-Lawrence grades 0-3). This Technical Note describes the surgical technique for Agili-C implantation and highlights key technical pearls to optimize outcomes.