Cell suspensions are used in autologous chondrocyte implantation. Periosteum is covered water-tight over the defect suturing it to the in tact cartilage. Second session requires arthrotomy. Arthrotomy and the use of periosteum are prone to complications. Standard monolayer cell culture conditions force chondrocytes to phenotypic dedifferentiation. Injection of suspension results in nonhomogenous distribution of cells, these cells may be lost by leakage through the periosteal graft and surgical time is long. To solve these problems, matrix guided autologous chondrocyte implantation was described in 1999. Since 2002, matrix guided autologous chondrocyte implantation, in which three dimensional biodegradable matrixes are used and which is referred to as the second generation autologous chondrocyte implantation, has been used as a treatment modality.