Archived Policies - Surgery


Osteochondral Grafts in the Treatment of Articular Cartilage Lesions

Number:SUR705.020

Effective Date:12-18-2001

End Date:12-31-2004

Coverage:

Osteochondral Autografting or Allografting, by MosaicPlasty, OATS or any Allografting system, using one or more cores of osteochondral tissue, is considered investigational as a technique to repair chondral defects (such as the patella, fibula, tibia, and ankle).

Description:

Focal chondral defects of the knee, due to trauma or other conditions such as osteochondritis dissecans often fail to heal on their own and may be associated with pain, loss of function, disability, and the long-term complication of osteoarthritis. The ideal resurfacing technique would eliminate the symptoms, restore normal biomechanics of the knee joint, and prevent the long-term emergence of osteoarthritis and the necessity for total knee replacement.

The use of both fresh and cryopreserved allogeneic osteochondral grafts has been encouraging. Cryopreservation decreases the viability of cartilage cells and fresh allografts may be difficult to obtain. Autologous grafts have been under investigation and have been limited by the small number of donor sites. Single grafts have been harvested from the patella, femoral condyle, and proximal part of the fibula. Two separate procedures are being used to harvest the osteochondral cores. They are Osteochondral MosaicPlasty and Osteochondral Autograft Transfer System (OATS). Although these procedures may use different instrumentation, the underlying principle to obtain the autografts is the same. Clinical studies have begun by using osteochondral grafts to repair chondral defects of the patella, tibia, and ankle.

Rationale:

The available scientific literature published in the peer-reviewed literature is inadequate to evaluate the effectiveness and durability of either the MosaicPlasty or OATS procedures. While randomized clinical trials focusing on treatment options for chondral defects is admittedly difficult to conduct, the available case series are both small in number, contain heterogenous patients and lack complete follow up to permit conclusions. There is also no long-term follow-up regarding potential morbidity related to multiple donor sites.

Contract:

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coding:

None


Medicare Coverage:

None

References:

None

Policy History:

Archived Document(s):

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