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 and create concerns regarding infectious diseases.

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. Alternatives to osteochondral allografting include abrasion chondroplasty, osteotomy and total knee replacement, arthrodesis (fusion) or prosthetic arthroplasty of the ankle.

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

BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2015). Autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved January 7, 2016 from BlueWeb. (60 articles and/or guidelines reviewed)

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

Gross, C., Adams, S., Easley, M., and Nunley, J. (2016, January) 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.

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)

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.

ORIGINAL EFFECTIVE DATE:  5/1/2001

MOST RECENT REVIEW DATE:  3/10/2016

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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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