BlueCross BlueShield of Tennessee Medical Policy Manual

Osteochondral Autografting (OCG)


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.





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

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. Evidence Positioning System. (5:2020). Autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved February 8, 2021 from (59 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, 26 (7), 2142-2157. (Level 1 evidence)

Lambers, K., Dahmen, J., Reilingh, M., van Bergen, C., Stufkens, S., & Kerkhoffs G. (2018). No superior surgical treatment for secondary osteochondral defects of the talus. Knee Surgery, Sports Traumatology, Arthroscopy, 26 (7), 2158–2170. (Level 2 evidence)

National Institute for Health and Care Excellence. (2017, October). Autologous chondrocyte implantation for treating symptomatic articular cartilage defects of the knee. Retrieved May 21, 2019 from

National Institute for Health and Care Excellence. (2018, March). Mosaicplasty for symptomatic articular cartilage defects of the knee. Retrieved July 6, 2018 from

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., & Inderhaug, E. (2017). Long-term clinical follow-up of microfracture versus mosaicplasty in articular cartilage defects of medial femoral condyle. Knee, 24 (6), 1402–1407. Abstract retrieved April 28, 2020 from PubMed database.

Toker, B., Erden, T., Cetinkaya, S., Dikmen, G., Ozden, V.E., & Taser, O. (2020). Long-term results of osteochondral autograft transplantation of the talus with a novel groove malleolar osteotomy technique. Joint Disease and Related Surgery, 31 (3), 509-515. (Level 4 evidence)

Winifred S. Hayes, Inc. Medical Technology Directory. (2017, July; last update search July 2020). Comparative effectiveness review of second-and third-generation autologous chondrocyte implantation of the knee. Retrieved February 9, 2021 from (84 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2017, May; last update search August 2020). Comparative effectiveness review of mosaicplasty for treatment of articular cartilage. Retrieved February 9, 2021 from (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.

Zamborsky, R., & Danisovic, L. (2020). Surgical techniques for knee cartilage repair: An updated large-scale systematic review and network meta-analysis of randomized controlled trials. Arthroscopy, 36 (3), 845-858. Abstract retrieved February 9, 2021 from PubMed database.




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