DESCRIPTION
Osteochondral autografting (OCG) is a surgical procedure used in an attempt to repair damaged articular cartilage. Mosaicplasty and osteochondral autograft transfer system (OATS) are types of this procedure.
The mosaicplasty procedure involves the harvesting of multiple individual osteochondral cores from the donor site, typically from a peripheral non-weight-bearing area of the femoral condyle. The grafts are pressed into the lesion in a mosaic-like fashion within the same-size drilled recipient tunnels. The resultant surface consists of transplanted hyaline cartilage and fibrocartilage arising from the abrasion arthroplasty. The fibrocartilage is thought to act as a grout between the individual autografts. Mosaicplasty is performed as an open procedure or arthroscopically.
The OATS procedure focuses on chondral defects associated with chronic tears of the anterior cruciate ligament (ACL). The procedure is performed arthroscopically.
Although mosaicplasty and OATS use different instrumentation, the underlying principle is similar. Both procedures use multiple osteochondral cores, harvested from a non-weight bearing region of the femoral condyle and autografted into the chondral defect.
POLICY
Osteochondral autografting, using one or more cores of osteochrondral tissue, for the treatment of symptomatic full thickness cartilage defects caused by acute or repetitive trauma in individuals who have had an inadequate response to a prior surgical procedure is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Osteochondral autografting for the treatment of other conditions/diseases, including, but not limited to, the following: patellar joint and talar joint is considered investigational.
Policies with similar titles:
MEDICAL APPROPRIATENESS
Osteochondral autografting, using one or more cores of osteochrondral tissue for the treatment of symptomatic full thickness cartilage defects caused by acute or repetitive trauma and for individuals who have had an inadequate response to a prior surgical procedure is considered medically appropriate if ALL of the following criteria are met:
The individual is skeletally mature with documented closure of growth plates (e.g., 15 years or older)
The individual is not considered an appropriate candidate for total knee arthroplasty or other reconstructive knee surgery (e.g., age less than 55)
Focal, full thickness (grade III or IV) uni-polar lesions on the weight bearing surface of the femoral condyles or trochlea that are between 1 and 2.5 cm2 in size
Documented minimal to absent degenerative changes in the surrounding articular cartilage (Outerbridge grade II or less),and normal appearing hyaline cartilage surrounding the border of the defect
Normal knee biomechanics, or alignment and stability achieved concurrently with autologous chondrocyte implantation
Absence of meniscal pathology
ADDITIONAL INFORMATION
Osteochondral autografting (OCG) is different from an autologous chondrocyte transplant. The autologous chondrocyte transplant requires a separate surgical procedure to harvest and transplant the cultured chondrocytes.
SOURCES
Alford, J. W., & Cole B. J. (2005). Cartilage restoration, part 1. The American Journal of Sports Medicine, 33 (2), 295-306.
Alford, J. W., & Cole B. J. (2005). Cartilage restoration, part 2. The American Journal of Sports Medicine, 33 (3), 443-460.
Aroen, A., Loken, S., Heir, S., Alvik, E., Ekeland, A., & Granlund, O.G., et al. (2004). Articular cartilage lesions in 993 consecutive knee arthroscopies. The American Journal of Sports Medicine, 32 (1), 211-215. (Level 2 Evidence - Independent study)
Beaman, F. D., Bancroft, L. W., Peterson, J. L., & Kransdorf, M. J. (2006). Bone graft materials and synthetic substitutes. Radiologic Clinics of America, 44 (3), 451-461.
BlueCross BlueShield Association. Medical Policy Reference Manual. (11:2008). Osteochondral autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved January 22, 2009 from BlueWeb. (25 articles and/or guidelines reviewed)
Bruce, E. J., Hamby, T., & Jones, D. G. (2005). Sports-related osteochondral injuries: Clinical presentation, diagnosis, and treatment. Primary Care: Clinics in Office Practice, 32, 253-276.
Canale, S. T., & Beaty, J. H. (Eds.). (2008). Campbell's Operative Orthopaedics (11th ed., pp. 2553-2558. Philadelphia: Mosby Elsevier.
Coons, D. A., & Barber, A. (2005). Arthroscopic osteochondral autografting. Orthopedic Clinics of North America, 36, 447-458.
Dozin, B., Malpeli, M., Cancedda, R., Bruzzi, P., Calcagno, S., Molfetta, L., et al. (2005). Comparative evaluation of autologous chondrocyte implantation and mosaicplasty: A multicentered randomized clinical trial. Clinical Journal of Sport Medicine, 15 (4), 220-226. Abstract retrieved February 6, 2009 from PubMed database. (Level 2 Evidence)
Hayes. Medical Technology Directory. (2005, June). Mosaicplasty. Retrieved November 24, 2008 from www.Hayesinc.com/subscribers. (26 articles and/or guidelines reviewed)
Magnussen, R., Dunn, W. R., Carey, J. L., & Spindler, K. P. (2008). Treatment of focal articular cartilage defects in the knee. A systematic review. Clinical Orthopaedics and Related Research, 466 (4), 952-962. (Level 4 Evidence - Industry sponsored)
Marcacci, M., Kon, E., Delcogliano, M., Filardo, G., Busacca, M., & Zaffagnini, S. (2007). Arthroscopic autologous osteochondral grafting for cartilage defects of the knee: Prospective study results at a minimum 7-year follow-up. The American Journal of Sports Medicine, 35 (12), 2014-2021. (Level 4 Evidence)
National Institute for Health and Clinical Excellence (NICE). (2006, March). Mosaicplasty for knee cartilage defects. Retrieved November 24, 2008 from http://www.nice.org.uk/nicemedia/pdf/ip/IPG162guiance.pdf.
ORIGINAL EFFECTIVE DATE: 10/1998
MOST RECENT REVIEW DATE: 6/13/2009
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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