Corporate Medical Policy Osteochondral Allograft Transplantation and Autograft Transfer System (OATS/mosaicplasty) in the Treatment of Articular Cartilage Lesions

Focal chondral defects of the knee, either 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 symptoms, restore normal biomechanics of the knee joint, and prevent the long-term emergence of osteoarthritis and the necessity for total knee arthroplasty. Various methods of cartilage resurfacing have been investigated including marrow-stimulation techniques such as subchondral drilling, microfracture, and abrasion arthroplasty, all of which are considered standard therapies and all of which attempt to restore the articular surface by inducing the growth of fibrocartilage into the chondral defect. However, fibrocartilage does not share the same biomechanical properties as hyaline cartilage, and thus various strategies for chondral resurfacing with hyaline cartilage have been investigated. Autologous chondrocyte implantation involves the harvesting of normal chondrocytes from normal non-weight-bearing articular surfaces, which are then cultured and expanded in vitro and then transplanted back into the patient. Autologous chondrocyte implantation is considered separately in policy No. 7.01.48.