Cell-Seeded Collagen Matrix-Supported Autologous Chondrocyte Transplantation (ACT-CS): A Consensus Statement on Surgical Technique

Objective: Autologous chondrocyte transplantation has become an established therapy for full-thickness cartilage defects. Cell-seeded collagen matrix-supported autologous chondrocyte transplantation (ACT-CS) has been introduced as a modification of conventional ACT, which allows easier handling and is intended to combine the advantages of using a cell suspension (i.e., cell viability and mitotic activity) with the stability and self-containment provided by a matrix of biomaterials. Unlike other techniques and products, this seeding step can be easily applied using a porcine collagen type I/III membrane and autologous chondrocytes in an operating room setting. Although some suturing is required, this technique provides the distinct advantage of not requiring a water-tight seal of the bilayer membrane, as is required using the classic cell suspension technique. Comparable to other modifications of ACT, the ACT-CS procedure requires a specific surgical technique that focuses on the following important details: (1) accurate debridement of the cartilage defect; (2) preparation of the cells, and seeding and containment of the cells within the transplantation site; and (3) sealing and suturing around the defect. Design: A consensus meeting of leading European orthopedic surgeons specializing in cartilage repair was convened to discuss and standardize the surgical aspects of this technique. Results & Conclusions: The present article describes and discusses the adoption of these best surgical practices for implementing the ACT-CS technique, including more detailed descriptions of each phase of the surgery in order to standardize and optimize patient outcomes.