BlueCross BlueShield of Tennessee Medical Policy Manual

Osteochondral Allografting

DESCRIPTION

Osteochondral allografting is a technique to repair full-thickness chondral defects of the knee caused by acute or repetitive trauma when other cartilage repair techniques (e.g., microfracture, osteochondral autografting or autologous chondrocyte implantation) would be inadequate due to the size, location, or depth of the lesion. Both fresh and cryopreserved allogeneic (from one person to another) osteochondral grafts have been used with some success, although cryopreservation decreases the viability of cartilage cells, and fresh allografts may be difficult to obtain.  The use of allogeneic 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.

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.

POLICY

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MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

The literature does not include enough good quality studies to demonstrate the benefit of using osteochondral allografting for treating any other joint problems except those of the articular surfaces of the knee.

SOURCES

Ahmad, J., & Jones, K. (2016). Comparison of osteochondral autografts and allografts for treatment of recurrent or large talar osteochondral lesions. Foot and Ankle International, 37 (1), 40 – 50. Abstract retrieved November 29, 2016 from PubMed database.

American Academy of Orthopaedic Surgeons. (2010). The diagnosis and treatment of osteochondritis dissecans. Guideline and evidence report. Retrieved November 29, 2016 from http://www.aaos.org/research/guidelines/OCD_guideline.pdf.

Assenmacher, A., Pareek, A., Reardon, P., Macalena, J., Stuart, M., & Krych, A. (2016). Long-term outcomes after osteochondral allograft: a systematic review at long-term follow-up of 12.3 years. Arthroscopy, 32 (10), 2160-2168. Abstract retrieved November 29, 2016 from PubMed database.

BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2015). Autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved November 18, 2016 from BlueWeb. (60 articles and/or guidelines reviewed)

Chui, K., Jeys, L., & Snow, M. (2015). Knee salvage procedures: the indications, techniques and outcomes of large osteochondral allografts. World Journal of Orthopedics, 6 (3), 340-350. (Level 4 evidence)

De Caro, F., Bisicchia, S., Amendola, A., & Ding, L. (2015). Large fresh osteochondral allografts of the knee: a systematic clinical and basic science review of the literature. Arthroscopy, 31 (4), 757-765. Abstract retrieved November 18, 2016 from PubMed database.

Gracitelli, G., Meric, G., Briggs, D., Pulido, P., McCauley, J., Belloti, J., & Bugbee, W. (2015). Fresh osteochondral allografts in the knee: comparison of primary transplantation versus transplantation after failure of previous subchondral marrow stimulation. The American Journal of Sports Medicine, 43 (4), 885-891. Abstract retrieved November 18, 2016 from PubMed database.

Gross, C., Adams, S., Easley, M., and Nunley, J. (2016) Role of fresh osteochondral allografts for large talar osteochondral lesions. Journal of the American Academy of Orthopaedic Surgeons. January 2016, Vol 24, No 1, e9-e17.

Sadr, K., Pulido, P., McCauley, J., & Bugbee, W. (2016). Osteochondral allograft transplantation in patients with osteochondritis dissecans of the knee. The American Journal of Sports Medicine, 44 (11), 2870-2875. Abstract retrieved November 29, 2016 from PubMed database.

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.

Van Tienderen, R., Dunn, J., Kusnezov, N., & Orr, J. (2016). Osteochondral allograft transfer for treatment of osteochondral lesions of the talus: a systematic review. Arthroscopy, 2016 Aug 18 [Epub ahead of print]. Abstract retrieved November 29, 2016 from PubMed database.

ORIGINAL EFFECTIVE DATE:  5/1/2001

MOST RECENT REVIEW DATE:  6/21/2017

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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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