Osteochondral autografting (OCG) is a surgical procedure used to repair full-thickness chondral defects involving a joint. Mosaicplasty and osteochondral autograft transfer system (OATS) are systems used to perform this procedure.
Mosaicplasty 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. 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.Autologous 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.
Osteochondral autografting for the treatment of chondral defects of the knee is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Osteochondral autografting for all other indications is considered investigational.
Osteochondral autografting for the treatment of focal articular cartilage lesions using autologous minced cartilage is considered investigational.
Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational.
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Osteochondral autografting is considered medically appropriate if ALL of the following criteria are met:
Indicated for ANY ONE of the following:
Cartilage defects of the knee if ALL the following are met:
Focal, full thickness (grade III or IV) unipolar lesions on the weight bearing surface of the femoral condyles, trochlea, or patella that are 1 - 2.5 cm2 in size
Symptomatic full-thickness cartilage defects caused by acute or repetitive trauma
Inadequate response to a prior surgical procedure (such as micro-grafting, autologous chondrocyte implantation)
There is evidence of growth plate closure in adolescents
There is a clinical determination that the individual is not yet a candidate for joint replacement
Documented minimal to absent degenerative changes in the surrounding articular cartilage (Outerbridge grade II or less)
Normal appearing hyaline cartilage surrounding the border of the defect
Normal knee biomechanics, or alignment and stability achieved concurrently with osteochondral autografting
Osteochondral lesions of the talus if ALL of the following are met:
Treatment is indicated for ANY ONE of the following:
Lesion greater than 1.5 cm2
Cystic lesion with volume greater than 3.0 cm
Revision surgery after failed marrow stimulation procedure
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Ahmad, J., & Jones, K. (2015). Comparison of osteochondral autografts and allografts for treatment of recurrent or large talar osteochondral lesions. Foot Ankle International. Abstract retrieved September 11, 2015 from PubMed database. (Level 2 evidence)
American Academy of Orthopaedic Surgeons. (2010). The diagnosis and treatment of osteochondritis dissecans. Guideline and evidence report. Retrieved June 29, 2017 from https://www.aaos.org/research/guidelines/OCD_guideline.pdf.
Astur, D.C., Arliani, G.G., Binz, M., Astur, N., Kaleka, C.C., Amaro, J.T., et al. (2014). Autologous osteochondral transplantation for treating patellar chondral injuries: evaluation, treatment, and outcomes of a two-year follow-up study. Journal of Bone & Joint Surgery, 96 (10), 816-823. Abstract retrieved July 25, 2016 from PubMed database.
Biant, L., McNicholas, M., Sprowson, A., & Spalding, T. (2015). The surgical management of symptomatic articular cartilage defects of the knee: Consensus statements from United Kingdom knee surgeons. The Knee, 22, 446-449. (Level 2 evidence)
BlueCross BlueShield Association. Medical Policy Reference Manual. (6:2017). Autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved June 28, 2017 from BlueWeb. (63 articles and/or guidelines reviewed)
Dahmen, J., Lambers, K., Reilingh, M., van Bergen, C., Stufkens, S., Kerkhoffs, G. (2017). No superior treatment for primary osteochondral defects of the talus. Knee Surgery, Sports Traumatology, Arthroscopy, 2017 Jun 27. Doi: 10.1007/s00167-017-4616-5. [Epub ahead of print]. Abstract retrieved June 29, 2017 from PubMed database.
Miller, D. J., Smith, M. V., Matava, M. J., Wright, R. W., & Brophy, R. H. (2015). Microfracture and osteochondral autograft transplantation are cost-effective treatments for articular cartilage lesions of the distal femur. American Journal of Sports Medicine, 43 (9), 2175-2181. Abstract retrieved September 11, 2015 from PubMed database. (Level 2 evidence)
National Institute for Health and Care Excellence. (2006). Mosaicplasty for knee cartilage defects. Retrieved July 25, 2016 from www.nice.org.uk/guidance/ipg162.
Pareek, A., Reardon, P., Maak, T., Levy, B., Stuiart, M., & Krych, A. (2016). Long-term outcomes after osteochondral autograft transfer: a systematic review at mean follow-up of 10.2 years. Arthroscopy: The journal of Arthroscopic and Related Surgery, 32 (6), 1174-1184. (Level 2 evidence)
Solheim, E., Hegna, J., Ǿyen, J., Harlem, T., & Strand, T. (2013). Results at 10 to 14 years after osteochondral autografting (mosaicplasty) in articular cartilage defects in the knee. The Knee, 20, 287-290. (Level 4 evidence)
Winifred S. Hayes. Medical Technology Directory. (2017, May). Comparative effectiveness review of mosaicplasty for treatment of articular cartilage injuries. Retrieved June 29, 2017 from www.Hayesinc.com/subscribers. (68 articles and/or guidelines reviewed)
Yasui, Y., Wollstein, A., Murawski, C., & Kennedy, J. (2017). Operative treatment for osteochondral lesions of the talus: biologics and scaffold-based therapy. Cartilage, 8 (1), 42-49. Abstract retrieved June 29, 2017 from PubMed database.
ORIGINAL EFFECTIVE DATE: 10/1998
MOST RECENT REVIEW DATE: 12/20/2017
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