Osteochondral Allograft Medical Necessity Determination

Primary Considerations

The American Academy of Orthopaedic Surgeons recommends osteochondral allograft for patients with lesions >2.5 cm² who are ≤50 years old, but prerequisites such as supervised physical therapy and meniscal status must be met 1
Bipolar lesions (both femoral and tibial involvement) are contraindications for isolated osteochondral allograft, as stated by The Journal of the American Academy of Orthopaedic Surgeons 2

Patients must have a full-thickness cartilage defect, with a size of ≥2 cm diameter, to be considered for osteochondral allograft, according to The American Academy of Orthopaedic Surgeons 1
The defect should be located on the weight-bearing surface, and the patient should have stable knee with negative Lachman, anterior/posterior drawer, and pivot shift tests, as recommended by The Journal of the American Academy of Orthopaedic Surgeons 3

For lesions <2 cm², autograft (mosaicplasty) is preferred, while for lesions 2-6 cm², osteochondral allograft is the first-line treatment, and for lesions >6 cm², osteochondral allograft is preferred due to donor site limitations with autograft, as stated by The American Academy of Orthopaedic Surgeons 1

Patients must complete and document at least 6 weeks of supervised, in-person physical therapy, with objective documentation of compliance and failure to achieve adequate symptom relief, as required by The American Academy of Orthopaedic Surgeons 1
Definitive imaging assessment of the tibial plateau is necessary to confirm the opposing articular surface is free of significant disease or injury, according to The American Academy of Orthopaedic Surgeons 1
Meniscal deficiency must be addressed, either by documenting adequate remaining meniscal tissue or planning concurrent meniscal allograft transplantation, as recommended by The American Academy of Orthopaedic Surgeons 1