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

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.

SOURCES

BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2013). Osteochondral autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved February 6, 2014 from BlueWeb. (50 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)

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). 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:  4/10/2014

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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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