BlueCross BlueShield of Tennessee Medical Policy Manual

Osteochondral Autografting (OCG)

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

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MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Osteochondral autografting (OCG) is different from an autologous chondrocyte transplant. The autologous chondrocyte transplant requires separate surgical procedures to harvest and transplant the cultured chondrocytes.

SOURCES  

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)

BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2011). Osteochondral autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved June 4, 2012 from BlueWeb. (30 articles and/or guidelines reviewed)

Coons, D. A., & Barber, A. (2005). Arthroscopic osteochondral autografting. Orthopedic Clinics of North America, 36, 447-458.

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)

National Institute for Health and Clinical Excellence (NICE). (2006, March). Mosaicplasty for knee cartilage defects. Retrieved November 24, 2008 from http://publications.nice.org.uk/mosaicplasty-for-knee-cartilage-defects-ipg162.

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.

Winfred S. Hayes. Medical Technology Directory. (2012, April). Mosaicplasty. Retrieved June 4, 2012 from www.Hayesinc.com/subscribers. (60 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  10/1998  

MOST RECENT REVIEW DATE:  7/26/2012

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