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Autologous Chondrocyte Implantation has proven to be a reliable treatment option for isolated large articular cartilage defects of the knee. As greater experience has come over the past decade, the indications have expanded to include more complex chondral or osteochondral lesions involving the femoral condyles and trochlea as well as the patella and infrequently the tibia. The importance of optimizing the intra-articular environment of the knee is an essential prerequisite to successful treatment of these more difficult defects. Alignment, stability, meniscal function and compliance with post-operative rehabilitation are all factors with need to be addressed in order to enhance the outcomes following chondrocyte implantation.