Since its introduction in 1987, autologous chondrocyte transplantation (ACT) for the management of full-thickness chondral defects of the knee has gained considerable attention and has renewed interest in cartilage repair. At this time there are patients with 10 to 13 years of follow-up who have continued to benefit from ACT. ACT is indicated for the management of full-thickness femoral articular Outerbridge grade III and IV lesions. Treatment of other surfaces such as the patella and tibia have also been successful. A thorough knowledge of patient selection and indications, good laboratory practices (GLP), standards of cell culturing, meticulous surgical technique, understanding of the normal time course of healing, the appropriate functional postoperative rehabilitation, and the management of specific ACT-related complications are all essential to good clinical outcomes. The success of this procedure with its excellent clinical outcomes and durability of the articular repair have made it a cost-effective procedure comparable to other technologies.