BlueCross BlueShield of Tennessee Medical Policy Manual

Osteochondral Autografting (OCG)

DESCRIPTION

Osteochondral autografting (OCG) is a surgical procedure used to repair full-thickness chondral defects involving the joint.  Mosaicplasty and osteochondral autograft transfer system (OATS) are systems used to perform this procedure.

Mosaicplasty 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. 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.

Autologous minced cartilage is also being evaluated as a treatment of articular cartilage lesions.  Currently, minced cartilage techniques are either not approved in the United States and/or in the early stages of development and testing.

POLICY

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MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Evidence is currently insufficient to evaluate the efficacy of osteochondral autografts for joints other than the knee. 

SOURCES

Ahmad, J., & Jones, K. (2015). Comparison of osteochondral autografts and allografts for treatment of recurrent or large talar osteochondral lesions. Foot Ankle International. Abstract retrieved September 11, 2015 from PubMed database. (Level 2 evidence)

Astur, D.C., Arliani, G.G., Binz, M., Astur, N., Kaleka, C.C., Amaro, J.T., et al. (2014). Autologous osteochondral transplantation for treating patellar chondral injuries: evaluation, treatment, and outcomes of a two-year follow-up study. Journal of Bone & Joint Surgery, 96 (10), 816-823. Abstract retrieved July 25, 2016 from PubMed database.

Biant, L., McNicholas, M., Sprowson, A., & Spalding, T. (2015). The surgical management of symptomatic articular cartilage defects of the knee: Consensus statements from United Kingdom knee surgeons. The Knee, 22, 446-449. (Level 2 evidence)

BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2015). Osteochondral autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved September 11, 2015 from BlueWeb. (60 articles and/or guidelines reviewed)

Miller, D. J., Smith, M. V., Matava, M. J., Wright, R. W., & Brophy, R. H. (2015). Microfracture and osteochondral autograft transplantation are cost-effective treatments for articular cartilage lesions of the distal femur. American Journal of Sports Medicine, 43 (9), 2175-2181. Abstract retrieved September 11, 2015 from PubMed database. (Level 2 evidence)

National Institute for Health and Care Excellence. (2006). Mosaicplasty for knee cartilage defects. Retrieved July 25, 2016 from www.nice.org.uk/guidance/ipg162.

Pareek, A., Reardon, P., Maak, T., Levy, B., Stuiart, M., & Krych, A. (2016). Long-term outcomes after osteochondral autograft transfer: a systematic review at mean follow-up of 10.2 years. Arthroscopy: The journal of Arthroscopic and Related Surgery, 32 (6), 1174-1184. (Level 2 evidence)

Solheim, E., Hegna, J., Ǿyen, J., Harlem, T., & Strand, T. (2013). Results at 10 to 14 years after osteochondral autografting (mosaicplasty) in articular cartilage defects in the knee. The Knee, 20, 287-290. (Level 4 evidence)

Winifred S. Hayes. Medical Technology Directory. (2012, April; last update search 2016, February). Mosaicplasty. Retrieved July 22, 2016 from www.Hayesinc.com/subscribers. (68 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  10/1998  

MOST RECENT REVIEW DATE:  3/9/2017

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