Some forms of artificial cartilage are already available. The Agili-C implant, made by CartiHeal (now part of Smith & Nephew), received FDA approval in 2022 and has been used in surgeries since then. But the technology is still in its early years, and access depends on your specific injury, your surgeon’s experience with the implant, and where you live. For most people with cartilage damage, the realistic question isn’t whether artificial cartilage exists, but whether it’s the right option for their knee right now.
What’s Already FDA-Approved
The Agili-C is the most notable product currently on the market. It’s an off-the-shelf scaffold made from aragonite, a form of calcium carbonate, that gets implanted into damaged cartilage and encourages new tissue to grow into it. Unlike older techniques that require harvesting cells from your own body and growing them in a lab, this implant comes ready to use. It’s approved for cartilage defects in the knee, including cases of mild to moderate osteoarthritis.
Surgeons at major medical centers began using it in late 2023 and into 2024. UC Davis Health reported one of the early U.S. cases in December 2023, where an orthopedic surgeon implanted the device in a patient who had struggled to heal from a knee injury. The procedure is still concentrated at specialized sports medicine and orthopedic centers, so availability varies significantly by region.
How Well the Agili-C Works
The clinical data so far is encouraging, especially compared to standard surgical options. In the largest randomized controlled trial, patients who received the Agili-C implant saw twice the improvement in knee function scores compared to the control group at two years. The responder rate, defined as achieving at least a 30-point improvement on a standard knee outcomes scale, was 77.8% in the implant group versus 33.6% with standard surgical care.
Imaging results were even more striking: at 24 months, 88.5% of implant patients achieved more than 75% defect fill in their treated lesions, compared to just 30.9% in the standard care group. The failure rate was also lower at 7.2% versus 21.4%. A smaller long-term study following patients for an average of 6.5 years found only one failure requiring revision surgery, which is promising but based on limited numbers.
That said, the technology isn’t perfect. In a study of 86 patients with mild to moderate osteoarthritis, about 9% needed their implant removed within two years, mostly due to the scaffold not integrating properly with the surrounding bone or due to infection. Long-term durability beyond five years hasn’t been well established yet.
How It Compares to Current Treatments
The standard surgical treatment for cartilage defects has been microfracture, a technique where tiny holes are drilled into the bone beneath the damaged cartilage to stimulate healing. It works reasonably well for small defects but produces fibrocartilage, a tougher, less resilient tissue than the original hyaline cartilage.
In a head-to-head trial of a biphasic cartilage repair implant versus microfracture, both groups showed similar functional improvement at 12 months. But MRI scans told a different story: 44.4% of implant patients showed fully regenerated cartilage compared to 31.1% with microfracture. Only 2.2% of implant patients showed no regeneration at all, versus 11.1% with microfracture. The trade-off was slightly more swelling in the implant group (51% versus 33%).
Other established options include osteochondral autograft transfer (using plugs of your own cartilage from a less-used area) and autologous chondrocyte implantation, which involves harvesting your cartilage cells, growing them in a lab, and reimplanting them weeks later. These work well but require two procedures, are limited by donor tissue, and come with longer recovery timelines.
What’s Still in Development
Several next-generation approaches are in the pipeline but not yet ready for widespread clinical use. Hydrogel-based implants, particularly those using polyvinyl alcohol, are being engineered to closely mimic the slippery, load-bearing properties of natural cartilage. Lab studies show that certain hydrogel blends produce friction levels similar to cartilage-on-cartilage contact, which is the gold standard. However, durability remains a challenge: these materials are prone to wearing down under repeated stress, and only hydrogels prepared at higher concentrations have shown acceptable volume retention.
3D bioprinting is further behind. Researchers have successfully printed cartilage-like structures in the lab and, in one notable case, bioprinted ear cartilage scaffolds seeded with a patient’s own cells for children with underdeveloped ears. But for knee cartilage, only one clinical trial involving 3D bioprinted grafts has been identified in the literature. The leap from printing cartilage that looks right under a microscope to producing tissue that survives decades of walking, running, and climbing stairs is substantial. Realistic timelines for 3D bioprinted knee cartilage reaching clinical use are likely measured in years, not months.
Who Can Get It Now
The Agili-C implant is approved for chondral and osteochondral lesions in the knee, which covers both surface cartilage damage and defects that extend into the underlying bone. It’s also indicated for patients with mild to moderate osteoarthritis, classified as Kellgren-Lawrence grades 0 through 3. That means it covers a broad range of cartilage problems but excludes people with severe, bone-on-bone arthritis. For those patients, total knee replacement remains the primary surgical option.
Your age, activity level, defect size, and the overall condition of your knee all factor into whether you’re a candidate. Younger, active patients with isolated cartilage injuries tend to be the best fit. If you’re interested, the most direct path is asking an orthopedic surgeon who specializes in cartilage restoration whether they have access to the implant and whether your specific damage pattern is appropriate for it.
Recovery After Cartilage Implant Surgery
Recovery follows a predictable arc regardless of the specific implant used. For the first four to six weeks, you’ll be non-weight-bearing on crutches to protect the healing tissue. Some procedures allow partial weight-bearing earlier, but most surgeons err on the side of caution during this phase while prioritizing gentle range-of-motion exercises to prevent stiffness.
From weeks 6 through 12, you’ll gradually transition to full weight-bearing and begin strengthening exercises. Months 3 through 6 involve more functional training, including agility drills if you’re planning to return to sports. Full return to high-impact activity typically happens somewhere between 6 and 12 months, depending on the procedure and healing progress. Clearance is based on functional testing and imaging, not just the calendar.
This timeline is notably longer than recovery from microfracture, where light activity can resume in 4 to 6 months. For scaffold-based implants that aim to regenerate true hyaline-like cartilage, the tissue needs more time to mature and integrate before it can handle heavy loads.
Cost and Insurance Coverage
Cost information for the Agili-C and similar implants is not widely published, and insurance coverage varies. Because these are relatively new devices, not all insurers have established coverage policies. Some may classify the implant as investigational and deny coverage, while others may approve it on a case-by-case basis given its FDA clearance. If you’re considering the procedure, contacting both the surgical center and your insurance provider early in the process will save you from surprises. The implant cost itself is only part of the equation, since the surgical facility fees, anesthesia, and rehabilitation add up as well.