BlueCross BlueShield of Tennessee Medical Policy Manual

Osteochondral Allografting

DESCRIPTION

Damaged articular cartilage can be associated with pain, loss of function, disability, and can lead to debilitating osteoarthrosis over time. These manifestations can severely impair an individual’s activities of daily living and quality of life. Most osteochondral lesions occur in the knee with the ankle and elbow being the next most frequent sites. The most common location of lesions is the medial femoral condyle (69%), followed by the weight-bearing portion of the lateral femoral condyle (15%), the patella (5%) and trochlear fossa. Talar lesions of the ankle are reported to be about 4% of osteochondral lesions.

Allogeneic grafts of osteochondral or chondral tissue have been proposed as treatment alternatives for individuals with clinically significant, symptomatic, focal defects of the articular cartilage. It is hypothesized that the implanted graft’s chondrocytes retain features of hyaline cartilage that is similar in composition and property to the original articulating surface of the joint. Osteochondral fresh allografting may be appropriate for large lesions of the knee or talus after failed marrow stimulation.

POLICY

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MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Current evidence does not support the use of osteochondral allografting for joints other than the knee and ankle.

SOURCES

Ahmad, J., & Jones, K. (2016). Comparison of osteochondral autografts and allografts for treatment of recurrent or large talar osteochondral lesions. Foot and Ankle International, 37 (1), 40 – 50. Abstract retrieved November 29, 2016 from PubMed database.

American Academy of Orthopaedic Surgeons. (2010). The diagnosis and treatment of osteochondritis dissecans. Guideline and evidence report. Retrieved November 29, 2016 from http://www.aaos.org/research/guidelines/OCD_guideline.pdf.

Assenmacher, A., Pareek, A., Reardon, P., Macalena, J., Stuart, M., & Krych, A. (2016). Long-term outcomes after osteochondral allograft: a systematic review at long-term follow-up of 12.3 years. Arthroscopy, 32 (10), 2160-2168. Abstract retrieved November 29, 2016 from PubMed database.

BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2017). Autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved June 27, 2017 from BlueWeb. (63 articles and/or guidelines reviewed)

Chui, K., Jeys, L., & Snow, M. (2015). Knee salvage procedures: the indications, techniques and outcomes of large osteochondral allografts. World Journal of Orthopedics, 6 (3), 340-350. (Level 4 evidence)

De Caro, F., Bisicchia, S., Amendola, A., & Ding, L. (2015). Large fresh osteochondral allografts of the knee: a systematic clinical and basic science review of the literature. Arthroscopy, 31 (4), 757-765. Abstract retrieved November 18, 2016 from PubMed database.

Gracitelli, G., Meric, G., Briggs, D., Pulido, P., McCauley, J., Belloti, J., & Bugbee, W. (2015). Fresh osteochondral allografts in the knee: comparison of primary transplantation versus transplantation after failure of previous subchondral marrow stimulation. The American Journal of Sports Medicine, 43 (4), 885-891. Abstract retrieved November 18, 2016 from PubMed database.

Gross, C., Adams, S., Easley, M., and Nunley, J. (2016) Role of fresh osteochondral allografts for large talar osteochondral lesions. Journal of the American Academy of Orthopaedic Surgeons. January 2016, Vol 24, No 1, e9-e17.

Ramponi, L., Yasui, Y., Murawski, C., Ferkel, R., DiGiovanni, C., Kerkhoffs, G., et al. (2017). Lesion size is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a systematic review. American Journal of Sports Medicine, 45 (7), 1698-1705. Abstract retrieved June 27, 2017 from PubMed database.

Sadr, K., Pulido, P., McCauley, J., & Bugbee, W. (2016). Osteochondral allograft transplantation in patients with osteochondritis dissecans of the knee. The American Journal of Sports Medicine, 44 (11), 2870-2875. Abstract retrieved November 29, 2016 from PubMed database.

U.S. Food and Drug Administration. (2005, February). Center for Devices and Radiological Health. 510(k) Premarket notification database. K043421. Retrieved January 26, 2012 from http://www.accessdata.fda.gov/cdrh_docs/pdf4/K043421.pdf.

Van Tienderen, R., Dunn, J., Kusnezov, N., & Orr, J. (2017). Osteochondral allograft transfer for treatment of osteochondral lesions of the talus: a systematic review. Arthroscopy, 33 (1), 217-222. Abstract retrieved June 27, 2017 from PubMed database.

ORIGINAL EFFECTIVE DATE:  5/1/2001

MOST RECENT REVIEW DATE:  12/20/2017

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