Cell-based, for larger defects
Agili-C — FDA-approved 2022
Native cartilage + bone grafts
Minimally invasive, where possible
Cartilage Restoration by the Numbers
Research-backed outcomes for modern cartilage restoration techniques in appropriate patients.
Why Treat It Early
Cartilage doesn't heal itself — so timing matters
Cartilage is the smooth surface that lets your joint glide without friction. When it's damaged by injury or wear, it doesn't repair well on its own — leading to pain, swelling, catching, and, over time, progressive arthritis.
Restoration is designed to rebuild a smoother surface, reduce pain, and slow that progression — especially valuable for younger, active patients who want to preserve the natural joint.
You may be a candidate if you have
- A focal cartilage injury (not widespread arthritis)
- Knee pain, swelling, or catching with activity
- A younger or active lifestyle
- A goal of avoiding or delaying knee replacement
This list is educational, not a diagnosis. Candidacy is confirmed with imaging and exam.
The Techniques
Matched to your defect — not one-size-fits-all
The right technique depends on the size and depth of the defect, bone involvement, and arthritis status.
MACI
Cell-based · larger defectsMatrix-induced autologous chondrocyte implantation (MACI) is an arthroscopic, cell-based resurfacing — your own cartilage cells are grown on a collagen membrane and implanted through small incisions to resurface larger defects with hyaline-like cartilage. Because MACI is a two-stage procedure — a cartilage biopsy, then arthroscopic implantation — the arthroscopic approach is designed for a faster, less invasive recovery than open surgery. Dr. Morton performed Hawai‘i's first arthroscopic MACI.
CartiHeal (Agili-C)
FDA-approved 2022A scaffold implant that can address cartilage and osteochondral defects — and, uniquely, is uniquely indicated for cartilage and osteochondral defects in knees with mild-to-moderate osteoarthritis, expanding who can be treated.
OATS
Native cartilage + boneOsteochondral autograft/allograft transplantation moves healthy cartilage-and-bone plugs into the defect — excellent for osteochondral lesions where bone is involved.
Microfracture
Small defectsTiny holes in the bone stimulate the body to form new (fibro)cartilage. Best for small lesions in younger patients; durability declines over time, so selection matters.
Allograft transplantation
Larger defectsDonor cartilage restores larger defects when autograft tissue is limited — sized and matched to your joint surface.
See It In Action
Watch: how these procedures work
Short animations of the CartiHeal (Agili-C) implant and the two-stage MACI procedure.
Videos are educational animations from the device manufacturers, not a promise of results. Whether a technique fits your knee is determined by imaging and exam.
The Evidence, Side by Side
Comparing cartilage restoration options
A simplified summary to guide the conversation. Your surgeon will recommend what fits your knee.
| Feature | Microfracture | MACI | OATS | CartiHeal (Agili-C) |
|---|---|---|---|---|
| Tissue formed | Fibrocartilage (scar-like) | Hyaline-like cartilage | Native hyaline + bone | Hyaline-like + bone |
| Best lesion size | < 2 cm² | > 2 cm² | 1–4 cm² (autograft) | Small to large |
| Durability* | Declines after 2–5 yrs | ~80–90% at 10 yrs | ~82–90% at 10 yrs | Strong 2–5 yr; 10 yr TBD |
| Early arthritis | Not effective | Not indicated | Limited use | May be effective |
| FDA status (U.S.) | Standard technique | Approved | Approved | Approved (2022) |
*Figures are approximate ranges summarized from the orthopedic literature and are provided for education only. Outcomes depend on defect size, location, bone involvement, activity level, and rehabilitation. Individual results vary. Figures reflect ranges reported across the orthopedic literature.
Why we work to save the meniscus
The meniscus is your knee's shock absorber — and it protects the cartilage underneath. Removing it can accelerate cartilage wear, so when a tear is repairable, repair is preferred over removal.
Meniscus root tears deserve special attention: biomechanically, an untreated root tear can behave much like removing the whole meniscus, raising the risk of rapid cartilage loss. Root repair is designed to re-anchor the meniscus and restore its natural "hoop stress" function.
Meniscus Preservation
Meniscus repair & root repair
- Arthroscopic meniscus repair to preserve tissue when the tear pattern allows.
- Meniscus root repair to re-anchor the meniscus and protect your cartilage.
- Considered alongside cartilage restoration as part of a joint-preservation plan.
Not every tear is repairable. The best option depends on the tear type, location, and tissue quality.
2-Minute Check
Am I a candidate for cartilage restoration?
Answer a few quick questions. This is educational and is not a diagnosis — only an evaluation can tell for sure.
Do you have knee pain, swelling, or catching with activity?
Are you relatively young or active and hoping to avoid a joint replacement?
Has a provider mentioned focal cartilage or meniscus damage (rather than widespread arthritis)?
You may be a strong candidate.
Your answers suggest cartilage restoration could be a good fit. The next step is a simple evaluation, where we'll confirm with an exam and imaging and review every option with you — surgical and non-surgical.
This tool is educational and not a diagnosis. Not everyone is a candidate; only a clinical evaluation can determine what's right for you.
You might be a candidate — let's talk.
Some of your answers point toward cartilage restoration, but the right path depends on the details. A short evaluation will give you a clear, honest answer and a plan.
This tool is educational and not a diagnosis. Not everyone is a candidate; only a clinical evaluation can determine what's right for you.
Let's take a closer look.
Your answers don't point clearly to cartilage restoration yet — but that doesn't mean we can't help. We'll evaluate what's going on and point you to the care that fits, often starting with non-surgical options.
This tool is educational and not a diagnosis. Not everyone is a candidate; only a clinical evaluation can determine what's right for you.
Answer all 3 questions to see your result.
Research & Evidence
Grounded in the science of joint preservation
MACI
An FDA-approved, matrix-based autologous chondrocyte technique studied for larger cartilage defects, with durable outcomes reported in appropriate patients. Results vary.
CartiHeal (Agili-C)
FDA-approved in 2022; a scaffold implant studied for cartilage and osteochondral defects, including knees with mild-to-moderate arthritis. Longer-term data continues to mature.
Meniscus root repair
Biomechanical and clinical studies suggest untreated root tears accelerate cartilage loss, and that repair may better preserve the joint than removal in appropriate patients.
Summaries are educational and simplified from the orthopedic literature; they are not a promise of results. Dr. Morton will review the evidence relevant to your specific case. Key references: Saris D, et al. Am J Sports Med. 2014;42(6):1384–1394 (MACI vs. microfracture — SUMMIT randomized trial); CartiHeal (Agili-C) U.S. FDA premarket approval, 2022; Allaire R, et al. J Bone Joint Surg Am. 2008;90(9):1922–1931 (meniscus root biomechanics).
Restoration vs. Replacement
Two different tools, two different jobs
Cartilage restoration
- Preserves your natural joint
- Best for early, focal damage
- Biologic healing; longer recovery
Joint replacement
- Replaces the damaged joint surface
- Best for advanced arthritis
- Predictable, durable relief
The key idea: cartilage restoration is about buying time and preserving your joint. Because we offer both, our recommendation is guided by what's right for you.
Patient Reviews
What patients say
“I chose Dr. Morton for my total knee replacement surgery. From the first visit I felt very secure and comfortable with him. The surgery was very successful — I was walking without assistance after only 5 days. The level of care and kindness have been excellent.”
— Verified patient· Healthgrades review
“Dr. Morton was so patient with me and described carefully what was happening with my left knee. Thank you for your time and listening.”
— Judith G.· Google review
Review excerpts reflect individual patient experiences and may be lightly condensed. Results vary.
Questions, Answered
Cartilage restoration FAQ
What is cartilage restoration?+
Cartilage restoration is a set of surgical techniques that repair or regenerate damaged joint cartilage — including microfracture, MACI, OATS, and the CartiHeal Agili-C implant. The goal is to relieve pain, restore function, and preserve your natural joint.
What are MACI and CartiHeal?+
MACI is an arthroscopic, cell-based procedure — your own cartilage cells are grown on a collagen membrane and implanted to resurface larger defects with hyaline-like cartilage. CartiHeal (Agili-C) is an FDA-approved implant (2022) that can address cartilage and osteochondral defects, including knees with mild-to-moderate osteoarthritis. Which option fits depends on your defect size, bone involvement, and arthritis status.
Do you repair the meniscus rather than remove it?+
When the tear pattern allows, we favor meniscus repair — including meniscus root repair — to preserve the meniscus, because the meniscus protects your cartilage. Not every tear is repairable; the right choice depends on the tear type, location, and tissue quality.
Will cartilage restoration mean I never need a replacement?+
Cartilage restoration is designed to preserve the natural joint and delay or avoid replacement, especially in younger, active patients with focal damage. Some patients may still need replacement later; restoring cartilage early often provides years of relief first. Individual results vary.
Are these procedures covered by insurance?+
Microfracture and OATS are generally covered by most plans. MACI is FDA-approved and widely covered, though prior authorization may be required. CartiHeal is newer and coverage is evolving. Our team helps verify benefits and obtain authorization.
Want to protect your natural knee?
Start with an evaluation. We'll review imaging together and tell you honestly whether cartilage restoration, meniscus repair, or another path fits you best.
For medical emergencies, call 911. This page is educational and is not a substitute for medical advice. Not everyone is a candidate; individual results and recovery vary.