title: Cell-Seeded Collagen Matrix-Supported Autologous Chondrocyte Transplantation (ACT-CS): A Consensus Statement on Surgical Technique.
abstract: 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.
  
  
  METHODS
  A consensus meeting of leading European orthopedic surgeons specializing in cartilage repair was convened to discuss and standardize the surgical aspects of this technique.
  
  
  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.
authors.affiliation: Center of Orthobiologics and Cartilage Repair, Schulthess Clinic, Zürich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Steinwachs
authors.affiliation: Department of Orthopedics, Gothenburg University, Gothenburg, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Peterson
authors.affiliation: Chester Knee Clinic & Cartilage Repair Centre, Nuffield Health, The Grosvenor Hospital Chester, United Kingdom.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Bobic
authors.affiliation: Department of Orthopedic Surgery, Ghent University Hospital, Ghent Belgium ; Roeselare Stedelijk Ziekenhuiis, Roeselare, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Verdonk
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Niemeyer
keywords: autologous chondrocyte implantation; cartilage defect; cartilage repair; cell transplantation; collagen membrane