What’s a good first case for the CARTIHEAL◊ Implant?

Introduction

Cartilage repair is arguably one of the most debated and evolving areas in sports medicine knee repair, involving both the limitations of conventional approaches (such as microfracture and debridement) and the challenges of more advanced techniques such as MACI, OATS or OCA.

It’s a difficult balance. Patients want pain relief, surgeons want positive outcomes, and healthcare systems need efficiency. On the other hand, cartilage repair can be synonymous with complexity, multi-stage procedures and uncertain clinical outcomes.

Enter Smith+Nephew’s CARTIHEAL^◊ AGILI-C^◊ Implant and its single-stage procedure, with the hope it could change the narrative and start addressing the balance. However, even as more surgeons look to adopt this off-the-shelf solution, they might still ask: “where could I start?”.

Full disclosure up front (read this first)

Everything in this blog is based on observations and surgeon opinion-based insights. We don’t offer medical advice, and we faultlessly defer to surgeons’ expertise...but we can aim to start a discussion. Surgeons will ultimately judge their best first case with the CARTIHEAL Implant (or any method for that matter). That much is not up for debate.

The CARTIHEAL Implant can be used on a range of chondral and osteochondral defects, but it just so happens that trochlea lesions are the subject of this particular blog. When we draw on the insights of surgeons who regularly use this relatively new repair method, notably Dr Andreas Gomoll and Dr Sabrina Strickland, we can use those insights as a basis of discussion (and it is only a discussion).

So, consider everything around patient selection to be surgeon opinion-based and open for debate as we look at why a trochlea procedure could be a great place to experience the CARTIHEAL Implant technique and to see the outcomes, respectful of the fact that all cases and patient circumstances can differ. 

Would you target the trochlea as a first CARTIHEAL Implant case?

Both Dr Strickland and Dr Gomoll are among surgeons who have described how they would target a central trochlear trough or fissure, with significant bone edema.^1,2 As well as the flat, contained geometry making it clear for surgical preparation and implant seating, these lesions are often moderate enough to warrant surgery but sufficiently manageable for an ideal first experience with the CARTIHEAL Implant.

On the presence of bone marrow edema, often identified in trochlear lesions, it arguably gives an effective basis to assess repair progress as the CARTIHEAL Implant restores the underlying bone^3-5 and helps to reduce the symptoms that are associated with edema (such as pain).¹

Dr Strickland notes in a VuMedi video on one step cartilage repair that it’s the “perfect lesion to start with”.

Add to this that the trochlea is technically straightforward to access, with clear visualization and unimpeded positioning to get accustomed to the instrumentation, and the picture becomes clearer. Plus, unlike a multi-compartment injury, trochlear lesions allow surgeons to focus on the key considerations and fundamental procedure steps of implantation rather than being distracted by complex concomitant pathology (more on this later).

Does the single-stage surgical procedure technique matter?

When adopting any new technique or technology, simplicity and reproducibility matter (irrespective of whether the technology claims to offer either one as a benefit). That’s why Dr Strickland calls out the trochlear lesion specifically in a VuMedi video focused on targeting the trochlear.

Notwithstanding the CARTIHEAL Implant’s universal single-stage approach for all indicated repairs, surgeons have summarized a number of key benefits in the context of trochlear repairs.

Easy arthroscopic (or mini-open) visualization of the trochlea anatomy means there’s no need for complex positioning or extensive dissection (which may be required for more complex posterior femoral condyle lesions). This ultimately translates to straightforward exposure.

When assessing the control of instrumentation, the flat, anterior surface of the trochlear allows clear preparation of the defect bed, hypothetically allowing removal of unstable cartilage and preparation of the subchondral bone with minimal difficulty.

Although the CARTIHEAL Implant is engineered for a press fit using a morse taper design in any indicated repair, the trochlea in particular allows surgeons to clearly see how the implant sits, for that additional element of reassurance in a first case that might not be as clear in other lesions.

The cumulative effect of these factors while treating the trochlea−both noted by Dr Strickland¹ when performing the procedure−makes a compelling combination for surgeons who are new to the CARTIHEAL Implant procedure and want to gain confidence.

Clear visualization could mean fewer surprises. Limited instrumentation use might help restrict technical variability; and clear and accessible implant seating might possibly build confidence in handling and using the technology. This is technically possible with other defect types, but trochlea cases could be a particularly effective introduction to all these key elements.

Watch the full video of Dr Strickland performing the trochlear lesions repair procedure here.

What about cartilage repair with concomitant injuries?

According to Dr Andreas Gomoll, cartilage repair surgery is not done in large numbers.² This leads us to examine what has been putting surgeons off (and how a trochlear lesion first case with an alternative treatment method could change that narrative).

A key element of the conversation, as Dr Gomoll remarks, is that hesitation around cartilage repair would emerge unless it involved concomitant ACL repair or meniscal allograft transplant.²

Do you think this is where the CARTIHEAL Implant could challenge that assumption? A single-stage procedure that’s effective as a standalone treatment or as a straightforward addition to other interventions, without jeopardizing outcomes or prolonging rehabilitation.

The historical tendency to see concomitant meniscus or ligament injuries as key determining factors in cartilage repair does not seem to apply to the CARTIHEAL Implant. When combined with the rationale for trochlea first cases above, could concomitant injuries or procedures result in a different thought process when involving the CARTIHEAL Implant?

Dr Gomoll believes it could change perceptions, and that:

“Cartilage treatment is not this arcane thing that unless you’re all in, you shouldn’t do it at all”.

What do you think? Could decision-making around concomitant injury change when using the CARTIHEAL Implant, or do you see it the same way?

Does this change cartilage repair for patients with osteoarthritis

A brief [but important] note for surgeons is that osteoarthritis need not stand in the way of a potential first trochlea case. The CARTIHEAL Implant remains the only device approved for the treatment of cartilage and osteochondral defects in patients with or without mild-moderate osteoarthritis (Kellgren-Lawrence 0-3).* This applies to any of the CARTIHEAL Implant’s indicated applications.

Are there benefits in cartilage repair rehabilitation and recovery?

Often a sticking point with cartilage repair surgery, post-op rehabilitation has been associated with prolonged periods of limited mobility where patients can’t bear weight. This potentially leads to difficulties with patient compliance and could, consequently, compromise outcomes.

This is where the CARTIHEAL Implant again changes the equation, and Dr Strickland calls this out specifically in trochlear lesion repair. She explains that one of the reasons why they’re a good lesion to start with is in her ability to encourage patients to bear weight6 (individual patient circumstances and associated surgeon judgments will differ).

The potential effect on rehabilitation is echoed in a webinar on patient selection for the CARTIHEAL Implant, with Dr Nirav Amin, Dr Jorge Chahla, Dr Andreas Gomoll and Kyle Martin reflecting on how patient selection, rehab compliance and outcomes are all impacted when the CARTIHEAL Implant is introduced.

Using trochlear lesions as a proving ground for the CARTIHEAL Implant might be the gateway for surgeons to change their post-operative recovery strategy and, essentially, start assessing the clinical results almost immediately in a highly symptomatic lesion.

Obviously, post-op rehabilitation still requires discipline on the part of the patient, under the expert guidance of the surgeon, but accounts of trochlea repair with the CARTIHEAL Implant demonstrate how the expectations and speed of weight bearing might change.¹

How does the CARTIHEAL Implant compare to other treatment options?

With a strong rationale for trochlea as an ideal first case in place, it’s pertinent to examine the other treatment options that might be considered.

For many years, microfracture and debridement have been the quiet workhorses of cartilage repair. Straightforward and widely available,⁶ it’s easy to see their appeal as go-to treatment options. Yet, these approaches have demonstrated limitations⁷ and can divide opinion.

As Dr Jorge Chahla said in a surgeon webinar (making a broader point on cartilage repair overall while analysing multi-compartment pathology):

“We’ve all seen microfracture fail in active patients within 2-3 years.”

Debridement is similarly underwhelming when it comes to clinical outcomes.⁷ Removing soft tissue might provide temporary relief but does little to halt the progression of defects.⁷

Those are seen as the conventional ‘surgical standard’, but we can only judge the trochlear lesions as an ideal first case for a CARTIHEAL Implant if we address all other treatment contenders.

MACI (Matrix-Induced Autologous Chondrocyte Implantation)

Undoubtedly a more advanced and cell-based approach than microfracture or debridement, with potential clinical benefits, but MACI differs substantially in that it requires a two-stage procedure⁸ as opposed to the CARTIHEAL Implant’s single-stage procedure. What’s more, when combined with the need for cell culture (again, not a requirement for the CARTIHEAL Implant) and specialized facilities, costs may start to accumulate.⁹

OATS (Osteochondral Autograft Transfer System)

Another option that can be effective for small lesions, but it’s worth looking at the potential limitations^10,11 when looking at multi-compartment defects. Don’t forget, we’re looking at an ideal starting point (not being limited to the trochlea) from the perspective of adopting the CARTIHEAL Implant across numerous lesion types. The donor site and size limitation concerns¹⁰ for the OATS approach might not reach the breadth of indications offered by the CARTIHEAL Implant.

OCA (Osteochondral Allograft)

Although a recognized grafting technique for trochlear lesions, OCA procedures are not without their difficulties. The primary concern being the removal of normal cartilage to facilitate the procedure, forcing the creation of a cylindrical defect from the original oblong lesion, for example, and using a fairly large graft.¹ Compound this with the fact that the cell-based treatment does not directly address the bone. Dr Strickland notes how the CARTIHEAL Implant addresses both issues directly.¹

No treatment at all

It’s true that many trochlear lesions might be left untreated…but there is a trade-off. Unquestionably straightforward and inexpensive as an option, but it could result in complications further down the line.

Focusing again on why trochlear lesions and the CARTIHEAL Implant are a great match, an initial experience with the technology can be achieved in a single procedure with no cell harvesting or donor site morbidity, in a lesion that is accessible and highly symptomatic to allow post-operative assessment.

Are these the four reasons to start with trochlea?

Based on the above discussion, trochlear lesions seem to emerge as an ideal first case for four key reasons: the anatomical nature of the lesion, the access and visualization of the procedure, the post-op rehabilitation and the potential patient impact (although not limited to trochlear lesions).

Not only do the characteristics of the lesion align perfectly with an accessible repair, but they are a relatively straightforward introduction to assessing the clinical results and broader application of the technology. As contained and manageable lesions, they could be perceived as more forgiving than starting with a more complex defect.

Obviously, each case will differ, but potential to expedite weight bearing could be a substantial benefit in getting post-operative rehabilitation underway. From a patient perspective, if given the option to choose a single procedure to have their cartilage repaired (rather than a two-stage procedure, for example, or to have their knee pain left untreated), it would be no surprise if the CARTIHEAL Implant emerged as a frontrunner.

Dr Strickland noted that she now has a “lower threshold to treat certain defects” since using the CARTIHEAL Implant.2 Once surgeons experience the straightforward nature of the procedure firsthand, with an osteochondral defect that facilitates access and visualization, could it inspire the confidence to explore the CARTIHEAL Implant’s various other repair indications? After all, the surgical steps for implantation and off-the-shelf convenience remain unchanged.

If you’re currently on the fence or looking to begin your journey with the CARTIHEAL Implant, sign up here to get the latest news, updates and videos sent straight to your inbox.

*Information accurate at the time of writing in February 2026.

This information is for educational and informational purposes only, and may not be appropriate for all jurisdictions. This information does not constitute and is not intended to be medical advice. Smith+Nephew does not provide medical advice. It is the treating health care provider’s responsibility to determine the best course of treatment for their patient based upon their professional medical judgment. For detailed information, including indications for use, contraindications, effects, precautions and warnings, please consult the product’s Instructions for Use (IFU) prior to use.