BlueCross BlueShield of Tennessee Medical Policy Manual

Osteochondral Autografting (OCG)


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.


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There is limited evidence in the form of randomized control studies to demonstrate the benefit of using osteochondral allografting for treating any other joint problems except those of the articular surfaces of the knee. The physician specialty societies and academic medical centers consider allografts reasonable for individuals with full-thickness chondral defects who meet specific criteria.


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)

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)

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)

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)

Radulesco, R., Cirstoiu, C., & Badila, A. (2010) Arthroscopical and histological study of cartilaginous lesions treated by mosaicplasty. Journal of Medicine and Life, 3 (4), 407-411. (Level 3 Evidence - Independent study)

Seo, S., Kim, C., & Jung, D. (2011). Management of focal chondral lesions in the knee joint. Knee Surgery and Related Research, 23 (4), 185-196.

Winifred S. Hayes. Medical Technology Directory. (2012, April; last update search 2015, March). Mosaicplasty. Retrieved September 11, 2015 from (68 articles and/or guidelines reviewed)




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