Autologous Chondrocyte Implantation (ACI) for Cartilage Defects of the Knee Using Novocart 3D and Novocart Inject

Ever since autologous chondrocyte implantation (ACI) has been introduced, there have been important advancements and progress leading to a more reliable and more standardized application of this technology. While first-generation ACI followed the principle of a cell-suspension being injected under an autologous periosteum patch, second and third generation ACI are characterized by the use of biomaterials, either using a cell-suspension (second generation) or a combination of cells and the biomaterial (third generation). Due to easier handling and improved clinical outcome, third generation ACI has become the gold standard for the use of ACI at this time. The present chapter focuses on the Novocart third generation ACI products. While Novocart 3D uses a collagen membrane and therefore an implantable biomaterial, Novocart Inject is a hydrogel-based ACI product that can be injected into cartilage defects. Both products are currently underway for central European market authorization by the European Medicinal Agency (EMA), additionally, an FDA-approval trial is underway for Novocart 3D. Product characteristics, indications, surgical techniques, and clinical outcomes are summarized in the present chapter.