BlueCross BlueShield of Tennessee Medical Policy Manual

Osteochondral Allografting

DESCRIPTION

Osteochondral lesions can occur in any joint but are most common in the knee and ankle. Such lesions are a tear or fracture in the cartilage covering one of the bones in a joint. The cartilage can be torn, crushed or damaged and, in rare cases, a cyst can form in the cartilage. Damaged articular cartilage can be associated with pain, loss of function, disability, and can lead to debilitating osteoarthrosis over time. These manifestations can severely impair an individual’s activities of daily living and quality of life. Most osteochondral lesions occur in the knee with the ankle and elbow being the next most frequent sites. The most common location of lesions is the medial femoral condyle (69%), followed by the weight-bearing portion of the lateral femoral condyle (15%), the patella (5%) and trochlear fossa. Talar lesions of the ankle are reported to be about 4% of osteochondral lesions.

Allogeneic grafts of osteochondral or chondral tissue have been proposed as treatment alternatives for individuals with clinically significant, symptomatic, focal defects of the articular cartilage. It is hypothesized that the implanted graft’s chondrocytes retain features of hyaline cartilage that is similar in composition and property to the original articulating surface of the joint. Osteochondral fresh allografting may be appropriate for large lesions of the knee or talus after failed marrow stimulation.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Current evidence does not support the use of osteochondral allografting for joints other than the knee and ankle.

SOURCES

American Academy of Orthopaedic Surgeons. (2010). The diagnosis and treatment of osteochondritis dissecans. Guideline and evidence report. Retrieved November 29, 2016 http://www.aaos.org.

American Orthopaedic Foot and Ankle Society. Position Statement. (2022). The use of osteochondral transplantation for the treatment of osteochondral lesions of the talus. Retrieved September 12, 2024 from https://www.aofas.org/.

Assenmacher, A., Pareek, A., Reardon, P., Macalena, J., Stuart, M., & Krych, A. (2016). Long-term outcomes after osteochondral allograft: a systematic review at long-term follow-up of 12.3 years. Arthroscopy, 32 (10), 2160-2168. Abstract retrieved November 29, 2016 from PubMed database.

Balazs, George.C., Wang, D., Burge, A.J., Sinatro, A.L., Wong, A.C., & Williams, R.J. (2018). Return to play among elite basketball players after osteochondral allograft transplantation of full-thickness cartilage lesions. Orthopaedic Journal of Sports Medicine, 6 (7), doi: 2325967118786941. (Level 4 evidence)

BlueCross BlueShield Association. Evidence Positioning System. (5:2024). Autografts and allografts in the treatment of focal articular cartilage lesions (7.01.78). Retrieved September 12, 2024 from https://www.bcbsaoca.com/eps/. (86 articles and/or guidelines reviewed)

Chui, K., Jeys, L., & Snow, M. (2015). Knee salvage procedures: the indications, techniques and outcomes of large osteochondral allografts. World Journal of Orthopedics, 6 (3), 340-350. (Level 4 evidence)

Gross, C., Adams, S., Easley, M., & Nunley, J. (2016). Role of fresh osteochondral allografts for large talar osteochondral lesions. Journal of the American Academy of Orthopaedic Surgeons, 24, e9-e17. (Level 5 evidence)

Kunze, K. N., Ramkumar, P. N., Manzi, J. E., Wright-Chisem, J., Nwachukwu, B. U., et al. (2023). Risk factors for failure after osteochondral allograft transplantation of the knee: a systematic review and exploratory meta-analysis. The American Journal of Sports Medicine, 51 (5), 1356-1367. Abstract retrieved September 12, 2024 from PubMed database.

Pereira, G. F., Steele, J. R., Fletcher, A. N., Clement, R. D., Arasa, M. A., & Adams, S. B. (2021). Fresh osteochondral allograft transplantation for osteochondral lesions of the talus: a systematic review. The Journal of Foot and Ankle Surgery, 60 (3), 585-591. Abstract retrieved September 12, 2024 from PubMed database.

Sadr, K., Pulido, P., McCauley, J., & Bugbee, W. (2016). Osteochondral allograft transplantation in patients with osteochondritis dissecans of the knee. The American Journal of Sports Medicine, 44 (11), 2870-2875. Abstract retrieved November 29, 2016 from PubMed database.

Van Tienderen, R., Dunn, J., Kusnezov, N., & Orr, J. (2017). Osteochondral allograft transfer for treatment of osteochondral lesions of the talus: a systematic review. Arthroscopy, 33 (1), 217-222. Abstract retrieved June 27, 2017 from PubMed database.

ORIGINAL EFFECTIVE DATE:  5/1/2001

MOST RECENT REVIEW DATE:  10/10/2024

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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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