Knee Cartilage Restoration

Overview

The right cartilage procedure isn't chosen from a menu — it's determined by the defect itself. Dr. Raffo weighs lesion size, bone involvement, containment, alignment, age, and whether early arthritis is present, and those factors point toward microfracture, MACI, osteochondral allograft, or Agili-C. This page lays out that decision framework directly.

How Dr. Raffo Performs This Procedure

Cartilage restoration begins with arthroscopic evaluation to confirm lesion size, depth, and containment, often combined with the primary imaging findings from MRI. From there the technique depends on the decision points below: microfracture and MACI are performed through a mix of arthroscopic and open exposure; osteochondral allograft transplantation involves press-fitting a size-matched cadaveric bone-and-cartilage plug; and Agili-C is implanted as an off-the-shelf scaffold in a single stage. When the knee is malaligned or the meniscus is deficient, a concomitant procedure — high tibial osteotomy, tibial tubercle osteotomy, or meniscal allograft transplantation — is planned alongside the cartilage work rather than deferred.

Who Is This For?

Patients with a symptomatic cartilage defect of the knee — pain, swelling, or catching localized to one area of the joint, usually confirmed on MRI — are candidates for some form of cartilage restoration. Good candidates are typically active adults who want to preserve the native joint rather than move straight to replacement. Cartilage restoration is not for patients with widespread, multi-compartment arthritis; once the whole joint surface is worn rather than one focal defect, restoring a single patch of cartilage will not relieve symptoms, and a different conversation — including robotic total knee replacement — becomes appropriate.

Recovery & Rehabilitation

Recovery timelines differ meaningfully by technique — MACI and OCA both require a period of protected weight-bearing measured in weeks, while Agili-C's published protocols allow a somewhat faster progression given its single-stage, cell-free design. General milestones across the framework:

• 0–6 weeks: Protected weight-bearing, and for two-stage procedures like MACI, the initial biopsy has typically already occurred weeks earlier.
• 6–12 weeks: Progressive weight-bearing and range-of-motion work begins in earnest.
• 3–6 months: Return to low-impact conditioning for most techniques.
• 9–14 months: Return to sport is assessed individually; pooled data across all cartilage procedures show a mean time to return to sport of 9.2 months, though this varies by technique — OAT averaged 6.6 months and ACI averaged 13.1 months in one pooled analysis (Kunze et al. 2025).