“…The outcome of these chondrocyte-based techniques is generally quite good (Minas, 2001;Peterson et al, 2000) but in many cases results in the formation of non-hyaline cartilage repair tissue with inferior mechanical properties and limited durability (Pelttari et al, 2009). ACI has several technical limitations: a) obtaining cartilage explants requires an additional surgical intervention, adding to the articular cartilage damage that increases the osteoarthritic process (Marcacci et al, 2002); b) in vitro chondrocyte proliferation must be limited because the capacity to produce stable cartilage in vivo is gradually reduced when cell divisions are increased (Dell´Accio et al, 2001); c) aging reduces the cellular density of the cartilage, which impacts chondrocyte proliferation capacity in vitro (Menche et al, 1998) and the chondrogenic potential of the periosteum (O´Driscoll & Fitzsimmons, 2001), d) cell culture procedures take too long (3 to 6 weeks) and increase the risk of contamination, e) risk of leakage of transplanted chondrocytes from the cartilage defects, f) the effects of gravity causing the chondrocytes to sink to the dependent side of the defect, resulting in an unequal distribution of cells that hampers the homogenous regeneration of the cartilage (Díaz-Prado et al, 2010c;Sohn et al, 2002), g) not the least the reacquisition of phenotypes of dedifferentiated chondrocytes in a monolayer culture (Kimura et al, 1984;Benya & Shaffer, 1982) and h) hypertrophy of tissue (Steinwachs & Kreuz, 2007;Haddo et al, 2004). The use of periosteum membrane poses constraints and the need for wide surgical incision, hypertrophy of the periosteum peripheral implant and its potential for ectopic calcification.…”