BlueCross BlueShield of Tennessee Medical Policy Manual

Osteochondral Allografting

DESCRIPTION

Osteochondral allografting is one of several types of cartilage transplant procedures used in the treatment of individuals with symptomatic, disabling cartilage injury or disease. The literature indicates that osteochondral allografting can provide significant relief of pain and improved joint function for individuals with focal articular cartilage defects due to trauma or osteochondritis dissecans. The procedure involves the transplantation of a piece of articular cartilage and attached subchondral bone to a damaged region of the articular surface of a joint. The goal is to provide viable chondrocytes and supporting bone that will be sufficient to maintain the cartilage matrix and thereby relieve pain and reduce further damage to the articular surface of the joint. Alternatives to osteochondral allografting include abrasion chondroplasty, osteotomy and total knee replacement, arthrodesis (fusion) or prosthetic arthroplasty of the ankle.

POLICY

Policies with similar titles:

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

The literature does not include enough 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. (6:2011). Osteochondral autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved January 26, 2012 from BlueWeb. (30 articles and/or guidelines reviewed)

Caldwell, P. E., 3rd, & Shelton, W. R. (2005). Indications for allografts. Orthopedic Clinics of North America, 36 (4), 459 - 467. (Level 5 Evidence)

Ghazavi, M. T., Pritzker, K. P., Davis, A. M., & Gross, A. E. (1997). Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. Journal of Bone and Joint Surgery. British Volume, 79 (6), 1008 - 1013. (Level 4 Evidence)

Gross, A., Kim, W., Las Heras, F., Backstein, D., Safir, O., & Pritzker,K. (2008). Fresh osteochondral allografts for posttraumatic knee defects: long-term followup. Clinical Orthopedic Related Research, 466 (8), 1863 - 1870. (Level 4 Evidence)

Jeng, C., Kadakia, A., White, K., Myerson, M. (2008). Fresh osteochondral total ankle allograft transplantation for the treatment of ankle arthritis. Foot Ankle International, 29 (6), 554 - 560. (Level 4 Evidence)

Turtel, A. (2005, March). Osteochondral ghrafting of articular cartilage injuries. Retrieved February 24, 2009 from http://www.emedicine.com/orthoped/topic595.htm.

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.

Winifred S. Hayes. Medical Technology Directory. (2000, September, Last update March 15, 2006). Osteochondral Allografting for the Knee. Retrieved January 27, 2012 from www.Hayesinc.com/subscribers. (22 articles and/ or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  5/1/2001  

MOST RECENT REVIEW DATE:  3/8/2012

ID_BA

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.

This document has been classified as public information.