Tissue Engineering and Regenerative Medicine

Cartilage, unlike bone, does not possess autogenous repair capability and has very limited ability to heal. It has been confirmed that cartilage injuries in the knee joint, if left untreated lead to more serious degenerative joint conditionsn (arthritis) and affect the activities of daily living with severe pain and dysfunction (disability). Cartiheal (Israel) recently CE marked the first in class acellular implant, Agili-C™, designed for joint resurfacing with simultaneous regeneration of hyaline cartilage and subchondral bone. The off-the-shelf implant, applied in a single stage procedure is composed of aragonite with hyaluronic acid functionalization at the cartilage phase. A long term (6 and 12 months) evaluation of the safety and efficacy in a 20 adult goats has been conducted following immediate load bearing: In the Agili-C TM group, the defects were healed and filled with a hyaline cartilage as confirmed by the marked presence of collagen type II and proteoglycans and absence of collagen type I. The subchondral plate and tidemark were reconstructed, whereas a poor repair was observed in the shamoperated group. Two clinical trials involving 148 patients showed over 24 months, a significant improvement of the primary endpoint KOOS score (pain, symptoms, quality of life) with a low rate of adverse events. Second look arthroscopies and MRI confirmed a high level of resurfacing.