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

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. (4:2018). Autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved July 6, 2018 from BlueWeb. (51 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. (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., 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)

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.




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