2007;15(7):851-856. Therefore, interventional studies (e.g., randomized controlled trials [RCTs], observational studies) are needed. Large osteochondral lesions have significant biomechanical consequences and often require resurfacing with osteochondral autograft transfer, mosaicplasty, autologous chondrocyte implantation (or similar methods) or osteochondral allograft transplantation. Comparison of revision rates in bone-patella tendon-bone autograft and allograft anterior cruciate ligament reconstruction. Others have reported "failures" in which patients have complained of persistent symptoms and joint effusion at 6 months after plug insertion and arthroplasty has been undertaken. Ankle and foot disorders. KOOS, SF-36 and VAS improved from a mean 58.5, 53.9 and 8.5 points to a mean 87.4, 86.6 and 1.2 at last follow-up (p < 0.001). MRI scans were obtained pre-treatment and at last follow-up. The meniscus (or menisci) refers to the lateral and medial crescent shaped cartilaginous tissues that are located at the junction of the tibia and femur which provide structural integrity to the knee and absorbs shock. Arthroscopy. A myriad of techniques for ankle cartilage allograft replacement exists. 2017;155(1):92-99. Revision reconstruction means corrective surgery when the original reconstruction has failed. In contrast to DeNovo ET (engineered tissue), DeNovo NT (natural tissue) is obtained directly from a juvenile allograft donor joint and the cartilage is then aseptically minced and packaged by the tissue processor. The use of bone graft in atrophic non-union may significantly reduce the bone healing time with good clinical results. Clin Orthop. These researchers examined outcomes of cryopreserved allografts used as a vascular conduit for bypass surgery in the infra-inguinal territory. clavicle, with or without internal fixation; with bone graft for nonunion or malunion (includes obtaining graft and/or necessary fixation) 23490 Prophylactic treatment (nailing, pinning, plating or wiring) with or without The authors concluded that combination of failure rates and fair/poor results indicated that all 3 procedures had unpredictable results. Gracitelli GC, Meric G, Pulido PA, et al. #backTop:hover { Prodromos C, Joyce B, Shi K. A meta-analysis of stability of autografts compared to allografts after anterior cruciate ligament reconstruction. The investigators cited Brucker and colleagues (2008)showing good outcomes of large-size OATS procedures in the knee femoral condyle. The average MOCART score was 46.8. Laurendon and co-workers (2017) noted that repair is indicated for tears in non-degenerative menisci. Int Orthop. D7950, Osseous, Osteoperiosteal, or Cartilage Graft of the Mandible or Maxilla - Autogenous or Nonautogenous, By Report. Single segment great saphenous vein (GSV), which provides the best conduit, is often not available and currently there is no consensus about the best alternative graft. 1994;303:67-78. When taking into account knees that either failed or had fair/poor function, the percentage of patients who failed to achieve a benefit averaged 22 % after PFA and 53 % after OA and ranged from 8 % to 60 % after ACI. OL LI { The guidelines panel also concluded that "[i]t is also appropriate to consider allograft and artificial ligaments only in very selected cases, discouraging widespread use, given the potential risks and paucity of well-performed, well-designed clinical studies.". Foot Ankle Int. Knee must be stableprior to surgery or be surgically corrected at the time of the allograft (i.e., intact or reconstructed ACL). Arthroscopy 2008;24(3):292-298. It is approved in Europe for the treatment of acute focal articular cartilage or osteochondral defects but is approved by the U.S. Food and Drug Administration only for backfill of osteochondral autograft sites. top: 0px; An allograft is tissue taken from one person for use in another person. Inclusionary criteria were English language, original clinical trials published from 1992 to 2012, patellar lesions 4 cm(2) or larger, mean patient age 50 years or younger, and all evidence levels. Arthroscopic treatment of osteochondral lesions of the talus using juvenile articular cartilage allograft and autologous bone marrow aspirate concentration. Fideler BM, et al. A novel, cryopreserved, viable osteochondral allograft designed to augment marrow stimulation for articular cartilage repair. The MOCART score for cartilage repair tissue on post-operative MRI averaged 61.1 points (range of 25 to 85 points). 2001;22(5):385-391. Clin Orthop. The number and type of re-operations were assessed. Pre-operative mean AOFAS hindfoot-ankle score was 49.6, and mean pain VAS score was 6.9. In conjunction with the treatment, 9 (38 %) ankles had 1 concomitant procedure and 9 (38%) had more than 1 concomitant procedure. At mean follow-up of 28.5 months, post-operative mean AOFAS score was 73, and mean pain VAS score was 4.5, representing overall improvements of 47 % and 35 %, respectively; 3 patients were considered treatment failures secondary to continued ankle disability (n = 2) or graft resorption requiring ankle arthrodesis. CPT Code Defined Ctgy Description 23900 Interthoracoscapular amputation (forequarter) 23920 Disarticulation of shoulder; . N-Force Blue is a bone graft substitute that resorbs and is replaced with new bone during the healing process. Cost analysis of outpatient anterior cruciate ligament reconstruction: Autograft versus allograft. A total of 46 patients with critical-size OCLs (greater than or equal to 6mm widest diameter) received JACI-BMAC from 2012 to 2014. Articular cartilage transplantation. First, a triplane tibial tubercle osteotomy (TTO) was performed, and the patella was everted 360 with a subvastus approach. Okeagu and colleagues (2017) stated that OLTs are an increasingly implicated cause of ankle pain and instability. Am J Orthop (Belle Mead NJ). UpToDate [online serial]. ol.numberedList LI { These investigators performed a systematic review of the clinical outcomes to evaluate the different techniques and clinical outcomes for ankle cartilage allograft replacement. Fresh osteochondral allografts for post-traumatic osteochondral defects of the knee. On stress radiographs, the mean talar tilt decreased from 14.3 5.4 to 3.1 2.4. 2015;6(1):12-19. Other studies have found significantly higher costs with use of allograft than autograft in ACL reconstruction, with little differences in operating room costs (Cooperand Kaeding, 2010; Naqda et al, 2010). Peri-procedural (30-day) mortality, amputation, and major adverse cardiac events are broadly similar across modalities. Verhaegen and colleagues (2015) performed a systematic search in 5 databases for clinical trials in which patients were treated with a TruFit plug for osteochondral defects. Improvement of gait speed was also observed only in the prosthesis group; EMG patterns at follow-up were strongly correlated with the corresponding control data for both groups. radial tear involving the popliteal hiatus. Several treatment methods exist with varying clinical outcomes. Am J Knee Surg. However, the authors concluded that the literature is still not sufficiently robust to draw firm conclusions regarding best practices for chondral defects. Arthroscopy. Radiographically, average follow-up was 28.1 months (range of 12 to 97 months). 2007;31(6):823-829. Spatio-temporal parameters showed a statistically significant improvement in cadence and cycle time. This review does not mention the use of allograft as a therapeutic option. Infections and important bone loss further reduce the therapeutic success. 1994;18(4):210-214. van Arkel E, de Boer HH. In some cases, patients voluntarily underwent diagnostic arthroscopic surgery with cartilage biopsy at 2 years post-op to assess the histological appearance of the cartilage repair. Hannon CP, Smyth NA, Murawski CD, et al. All identified RCTs and quasi-RCTs of operative treatment for CLAI were included. A total of 102 patients (68.5 %) had a grade IV lesion (Fontaine classification). list-style-type: upper-roman; 2004;20(2):129-140. Patients were evaluated pre- and post-operatively using the modified Merle d'Aubign-Postel (18-point) scale, the International Knee Documentation Committee (IKDC) pain, function, and total scores, and the Knee Society function (KS-F) score. Knee Surg Sports Traumatol Arthrosc. background: #5e9732; In the overall follow-up, 24.8 % of patients required a re-intervention. 2012;96(3):149-154. Dyslipidemia was related to a lower limb salvage rate and represents a risk factor involved in MALEs. The mean CMS for all scored studies was 53.6 of 100, and 5 areas were identified as methodologically weak: Saltzman and colleague (2017) reported on their institution's early results from juvenile particulate cartilage allograft transplantation of the talus. Fresh osteochondral allograft transplantation for isolated patellar cartilage injury. The investigators foundlimited high-quality evidencecomparing autograft to allograft. Clinical comparison of the Tutoplast allograft and autologous patellar tendon (bone-patellar tendon-bone) for the reconstruction of the anterior cruciate ligament: 2- and 6-year results. A total of 12 consecutive patients treated from March 2007 to April 2009 for OLT were evaluated. Noyes FR, Barber-Westin SD. Tissue-engineered cartilage constructs represent a highly promising treatment option for knee injury as they mimic the biomechanical environment of the native cartilage and have superior integration capabilities. Copyright 2023, AAPC Tendon allograft for reconstruction of the ACL should only be employed when an adequate autologous graft is not available for, Gross et al (2012) performed a systematic review of clinical outcomes after cartilage restorative and reparative procedures in the glenohumeral joint to. Clin Podiatr Med Surg. Noyes FR, Barber-Westin SD, Rankin M. Meniscal transplantation in symptomatic patients less than fifty years old. Long-term outcomes are important in the evaluation of interventions used in the field of orthopedic. Vascellari A, Rebuzzi E, Schiavetti S, Coletti N. All-inside meniscal repair using the FasT-Fix meniscal repair system: Is still needed to avoid weight bearing? Current Procedural Terminology (CPT) codes and Medicare Physician Fee Schedule values for common spine . This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. 2014;21(6):1185-1190. A systematic review. The clinical outcomes of talar OCA have been inconsistent relative to the positive results observed in other joints. The authors concluded that despite a low primary patency rate at 2 years, the secondary patency of arterial allografts was acceptable for distal bypasses. Int Orthop. OL OL LI { Desandis and associates (2018) noted that juvenile allogenic chondrocyte implantation (JACI; DeNovo NT Natural Tissue Graft; Zimmer, Warsaw, IN) with autologous bone marrow aspirate concentrate (BMAC) is a relatively new all-arthroscopic procedure for treating critical-size OCLs of the talus. These investigators described treatment of a trochlear defect with marrow stimulation augmented with this novel chondral allograft, along with 9-month post-operative histological results. For additional language assistance: Allograft, includes templating, cutting, placement and internal fixation, when performed, Ligamentous reconstruction (augmentation), knee; extra-articular, intra-articular (open) and extra-articular, Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction, Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction, Patellofemoral disorders and other derangements of patella [including lateral, medial, anterior and posterior ligaments], Other disorders of patella [including lateral, medial, anterior and posterior ligaments], Chronic instability of knee [including lateral, medial, anterior and posterior ligaments], Other spontaneous disruption of ligament(s) of knee and other internal derangements of knee [including lateral, medial, anterior and posterior ligaments], Arthroscopy, knee, surgical; osteochondral allograft(s) (e.g., mosaicplasty), Magnetic resonance (eg, proton) imaging, any joint of lower extremity, Osteonecrosis due to previous trauma, femur, Osteochondropathy, unspecified lower leg [osteochondral lesions of the distal femur], Congenital deformity of knee [femoral trochlear dysplasia], Congenital malformation of knee [femoral trochlear dysplasia], Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral, Ligamentous reconstruction (augmentation), knee, Magnetic resonance (e.g., proton) imaging, Derangement of medial and lateral meniscus, Tear of unspecified meniscus, current injury, Tear of articular cartilage of knee, current, Repair, primary, disrupted ligament, ankle; collateral, Repair, secondary, disrupted ligament, ankle, collateral, Bone graft with microvascular anastomosis; other than fibula, iliac crest, or metatarsal, Excision or currettage of bone cyst or benign tumor, talus or calcaneus; with allograft, Arthrodesis; pantalar; triple; or subtalar, Idiopathic aseptic necrosis of ankle and foot [talus], Osteonecrosis due to drugs, ankle and foot [talus] [avascular necrosis of bone], Osteonecrosis due to previous trauma, ankle and foot [talus] [avascular necrosis of bone], Other secondary osteonecrosis, ankle and foot [talus] [avascular necrosis of bone], Other osteonecrosis, ankle and foot [talus] [avascular necrosis of bone], Bone graft with microvascular anastomosis; metatarsal, Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with allograft, Disorder of bone, unspecified [chondral lesions of the hip], Disorder of cartilage, unspecified [chondral lesions of the hip], Other specified acquired deformities of musculoskeletal system [chondral defects of the hip], Unspecified dislocation of acromioclavicular joint [acromio-clavicular (AC) separation], Nontraumatic ischemic infarction of muscle. Okeagu CN, Baker EA, Barreras NA, et al. The spinal allograft codes are: +20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) +20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) Clin Podiatr Med Surg. The codes listed in the table below are representative of some of the possible procedures that may be performed utilizing BIO4. Overall, patients with infra-popliteal disease had higher patency rates of great saphenous vein graft at 1 and 2 years (primary: 87 %, 78 %; secondary: 94 %, 87 %, respectively) compared with all other interventions. The osteochondral allograft transplantation surgery technique allowed patients to have a stable, pain-free knee joint and participated in activities compared to non-operative management. Abnormal BPTB autograft stability was 6 % versus 16 % for BPTB allograft. J Bone Joint Surg Am. Based on the pathoanatomy of the lesion and availability of a bone bank providing fresh allograft, these researchers opted for an open anatomic reconstruction using a fresh glenoid allograft. Allograft procedures have become popular due to inherent advantages over other resurfacing techniques. Geraghty S, Kuang J-Q, Yoo D, et al. Increasing lesion size was associated with decreased FAOS quality of life (QOL) subscale and hypertrophy correlating with changes in the pain subscale. Average osteochondral lesion diameter was significantly larger in JACI-BMAC patients compared to MF patients, but size difference had no significant impact on outcomes. The accurate restoration of the normal anatomy is mandatory to obtain bone healing. Pain and function improved from the pre-operative visit to latest follow-up, and 89 % of patients were extremely satisfied or satisfied with the results of the OCA transplantation. These included 613 knees that underwent autologous chondrocyte implantation (ACI) (11 studies), 193 knees that had patello-femoral arthroplasty (PFA) (5 studies), and 34 knees that underwent osteochondral allografting (OA) (2 studies). However, they noted that the long-term outcomes of this procedure are unknown, and studies are needed. These investigators searched multiple databases through May 7, 2017 for prospective studies with at least 1-year follow-up that evaluated patient-relevant outcomes of infra-inguinal re-vascularization procedures in adults with CLTI. Effects of gamma irradiation on the human immunodeficiency virus. Foot Ankle Int. Vangsness and co-workers (2018) stated that restoration and repair of articular cartilage injuries remain a challenge for orthopedic surgeons. The Japanese Knee Injury and Osteoarthritis Outcome Score, Lysholm, Tegner, IKDC Subjective Knee Evaluation, and VAS scores were obtained. The Radiographic Union Score was 26.8 ( 2.2; range of 24.3 to 30) in the Allograft group versus 26.9 ( 2.8; range of 24.1 to 30) in the Autograft group. Intercalary allograft transplantation (+20933 and +20934) also uses human tissue to reconstruct bone defect(s) after tumor resection. Allografts are commonly used for ACL reconstruction. Further studies on this novel approach are needed, owing to the small number of lesions and relatively short follow-up time in this study. Dierckman and Ferkel (2015) noted that the modified Brostrom procedure has been successful for most patients with CLAI; however, a subset of patients has had unsatisfactory outcomes. Cao et al (2018) stated that a key point to surgical treatment of CLAI is choosing a suitable surgical procedure. Corrective osteotomies are indicated in accompanying axial mal-alignments. 2008;31(4):331-338. At 31 months' follow-up, there were 13 failures (15 %). Knee. Results and functional outcomes of structural fresh osteochondral allograft transfer for treatment of osteochondral lesions of the talus in a highly active population. Most patients demonstrated a persistent bone marrow edema pattern and hypertrophy of the reparative cartilage. The authors concluded that preliminary data from a challenging clinical population with large, symptomatic osteochondral lesions in the ankle suggested that treatment with particulated juvenile cartilage could improve function and decrease pain. DeSandis BA, Haleem AM, Sofka CM, et al. Karnovsky SC, DeSandis B, Haleem AM, et al. Almasri and associates (2018) stated that the optimal strategy for re-vascularization in infra-inguinal chronic limb-threatening ischemia (CLTI) remains debatable. Patients were evaluated with Magnetic Resonance Observation of Cartilage Tissue (MOCART) score for MRI assessment of the repair tissue. The authors concluded that this technique may represent a feasible alternative to bone transport or amputation, as it allowed the return to daily life activities. 2006;14(3):146-154. For example, the sample size is inadequately powered for anything other than an analysis of safety, only 3 surgeons participated, and the use of a single but experienced radiologist and pathologist prevents intra-rater reliability measurements. The main drawback of this study was its small sample size (n = 27) and its case-series design. padding-bottom: 4px; text-decoration: underline; Furthermore, UpToDate reviews on Clinical features and management of ankle pain in the young athlete (Chorley and Powers, 2014) Talus fractures (Koehler, 2014a) do not mention the use of allograft as a management tool. Another sterilization technique involves applying irradiation. Transplantation of so-called (osteochondral) mega grafts (e.g., autologous bone grafts or allografts) were used for very large osteochondral defects that cannot be reconstructed otherwise. These investigators presented a straight-forward, single-stage surgical technique of a novel reparative and restorative approach for articular cartilage repair with the implantation of a CVOCA. Giannini et al (2015) noted that bipolar fresh osteochondral allografts (BFOA) recently became a fascinating option for articular cartilage replacement, in particular in those young patients non-suitable for traditional replacement because of age. Mean post-operative IKDC score was 88.19 (range of 64.37 to 98.95). They stated that further studies are needed to examine the long-term outcomes and determine the superiority of the arthroscopic DeNovo procedure compared with microfracture and other cartilage resurfacing procedures. Synthetic resorbable polymers (eg, PolyGraft, TruGraft TruFit plugs) are polymer scaffolds that are being proposed for the repair of osteochondral articular cartilage defects. } The authors concluded that the CVOCA retained viable chondrocytes, chondrogenic growth factors, and ECM proteins within the intact architecture of native hyaline cartilage. Arthroscopy. Ankle & foot (acute & chronic). 2018;7(12):e1269-e1273. Although the precise pathophysiology has not been fully elucidated, it can be assumed that a variety of factors are responsible, mainly including traumatic events such as ankle sprains. padding: 10px; A review of the Medline database was performed involving searches for clinical outcomes of all-inside meniscus repair performed with the Fast-Fix device. Koehler SM. Current literature regarding OCA failure focuses mainly on 3 factors: the effect of graft storage conditions on chondrocyte viability, graft/lesion size, and operative technique. color: red!important; The graft is obtained from the knee of a donor; therefore, the cartilage will be thicker than the native glenoid articular cartilage. } Median VAS of pain decreased from 8 before surgery to 1 after surgery (p < 0.001). These researchers presented the clinical outcomes and detailed surgical technique of 4 cases in which they used a CVOCA for full cartilage replacement of the 1st metatarsal head to address degenerative articular cartilage damage. Moreover, these researchers stated that further studies are needed to evaluate the long-term clinical results of this surgical procedure. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Waltham, MA: UpToDate;reviewed January 2014b. UpToDate [online serial]. Because of its avascular nature, articular cartilage has a poor capacity for self-repair and regeneration. OPPS - Medicare's Outpatient Prospective Payment SystemAPC 5111 - Level 1 Musculoskeletal Procedures; APC 5113 - Level 3 Musculoskeletal Procedures; APC 5114 - Level 4 Musculoskeletal Procedures; APC 5115 - Level 5 Musculoskeletal ProceduresStatus Indicator J1 - Hospital Part B services paid through a comprehensive APC; T - Multiple procedure re. AmnioRepair is indicated for use as a biological barrier or wound cover. Chu CR, Convery FR, Akeson WH, et al. They reported the results of a retrospective case series of 3 patients who presented with articular cartilage lesions more than 2 cm2 and were treated with the CVOCA using the presented surgical technique. Garrett JC. The CVOCA contains full-thickness articular cartilage and a thin layer of subchondral bone, and maintains the intact native cartilage architecture with viable chondrocytes, growth factors, and extra-cellular matrix proteins to promote articular cartilage repair. The mean age of the patients was 33.7 years (range of 14 to 64); 54 % were female; 26 (92.9 %) knees had previous surgery (mean of 3.2 procedures; range of 1 to 10). grafts which can enhance bone regeneration. right: 30px; 2016;32(1):214-222. The number and type of re-operations were assessed. TruFit CB bone plug: Chondral repair, scaffold design, surgical technique and early experiences. Clinical analysis of 33 cases. Major adverse limb event (MALE)-free rate was 21.5 % at 5 years. In a case study, Anthony and Wolf (2015) presented the case of a 5- year old boy with a 2-year history of right knee pain and evidence of dysplasia epiphysealis hemimelica (DEH or Trevor's disease) on imaging who underwent initial arthroscopic resection of his lesion with subsequent recurrence. Rodriguez EG, Hall JP, Smith RL, et al. These investigatorsreported a case of delayed incorporation of an articular cartilage defect of the lateral femoral condyle treated with 3 TruFit plugs. Arthroscopy. The identification of these effects will also be useful in understanding whether MME precedes or follows progressive osteoarthritic changes in the knee. Meniscal substitutes -- human experience. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. list-style-type: lower-roman; The average lesion size was 125 75 mm2, and the average depth was 7 5 mm. } The advantages of using these allografts are a more abundant supply of tissue for multiple ligament and revision surgery, a shorter operative time, faster rehabilitation, avoidance of morbidity associated with autograft harvesting, as well as a lower incidence of stiff knee. The authors concluded that BFOA in the knee joint still remains an inapplicable option in the treatment of post-traumatic end-stage arthritis of the young patient, due to the high rate of failure. J Foot Ankle Surg. Subjects had an average age at surgery of 35.0 years and an average body mass index of 28 5.8. Fresh osteochondral allografts for posttraumatic knee defects: Long-term followup. CPT code 20398, on the other hand, defines a structural autograft that may more commonly be placed within an interspace to maintain height between the vertebrae. At 10 to 22 months of follow-up, patients reported clinical improvement, with VAS pain-scale scores decreasing from an average of 8.0 to 0 post-operatively, and ROM improvement from an average of 4.3 degrees to 58.3 degrees dorsiflexion. Am J Sports Med. In one study, nerve damage was more frequent in non-anatomic reconstruction group; the other one reported that radiological measurement of ankle laxity showed that non-anatomic reconstruction provided higher reduction of talar tilt angle. I thought about C1762, but would bone be considered connective tissue?? The study reported a good reliability of FFB allograft for large non-union bone defects. 1993;12(4):757-770. Cartilage viability is one of the most important factors for successful clinical outcomes after transplantation of osteochondral allografts and is related to storage length and intra-operative factors. 06/03/2022 The authors concluded that particulated juvenile articular cartilage (DeNovo NT) provides for a rapid, safe and effective treatment of cartilage defects with clinical outcomes showing significant improvement over baseline and histologically favorable repair tissue at 2 years. Ann Vasc Surg. Manipulated (decellularized) human tissue graft products (e.g., Chondrofix osteochondral allograft) are made of bone and cartilage tissue that is harvested from a cadaveric donor that has been processed to remove blood, cells and fat from the tissue. Waltham, MA: UpToDate;reviewed January 2017. 2001;18(1):161-176. A total of 7 RCTs were included for analysis. These methods involve the implantation of particulated articular cartilage from either autograft or juvenile allograft donor, respectively. 2014;22(1):46-56. A total of 25 patients were followed pre- and post-operatively through 2 years. Twenty-six (92.9 %) knees had previous surgery (mean of 3.2 procedures; range of 1 to 10). These codes represent the physician work involved in preparing and harvesting the bone graft to be used for the fusion/arthrodesis. Ankle arthroplasty via artificial or "biological" reconstruction is a viable option in those patients who are not comfortable with arthrodesis. Vansadia and colleagues (2016) stated that the risk factors for patella-femoral joint instability include laxity of medial patellar restraints, abnormal limb geometry, femoral and tibial mal-rotation, patella alta, and trochlear dysplasia. The investigators concluded that autografts are the graft of choice for routineACL reconstructionwith allografts better reserved for multiple ligament-injured knees where extra tissue may be required. There is extensive ongoing reseach focusing on strategies to repair and replace knee joint cartilage. Olympia, WA: Washington State Department of Labor and Industries; revised October 22, 2002. } Injury of articular cartilage due to trauma or pathological conditions isa major cause of disability worldwide. Talus fractures. Functional and clinical evaluation at 5-year follow-up of a three-component prosthesis and osteochondral allograft transplantation for total ankle replacement. However, the authors stated that further studies are needed to define the exact role of these procedures in the treatment of patello-femoral instability. A method of tissue processing and preservation was developed resulting in a CVOCA with pores and minimal bone. .newText { In an evidencereview of outcomes of posterior collateral ligament treatment,Hammoud et al (2010)cited evidence of good results with Achilles allograft and hamstring autograft for posterior cruciate ligament reconstruction. These researchers compared fresh-frozen bone (FFB) allograft and autograft in the treatment of forearm aseptic non-union. Hoffman and associates (2015) stated that marrow stimulation is often used for the treatment of focal chondral defects of the knee. J Orthop Traumatol. In a case-series study, Gracitelli et al (2016) evaluated functional outcomes and survivorship of the grafts among patients who underwent osteochondral allograft (OCA) for patellar cartilage injuries. Jordan MA, Van Thiel GS, Chahal J, Nho SJ. An osteoarticular bone allograft (20932) consists of bone, articular (joint) cartilage, and other soft tissues that is used to replace large defects, such as those caused by excision of a bone tumor involving adjacent tissue, including cartilage and tendons. Six failures occurred. identify prognostic factors that predict clinical outcomes, provide treatment recommendations based on the best available evidence, and. Only 1 patient, who received the allograft to convert a knee arthrodesis, gained a satisfactory result at the last follow-up control. Furumatsu T, Kodama Y, Kamatsuki Y, et al. Allograft tissue is matched by size to the individual, inserted into the knee joint and anchored to supporting structures by hardware, soft tissue or bony tissue fixation. Bone-patellar-tendon-bone (BPTB) autograft normal stability was 66 % versus 57 % for BPTB allografts (p < 0.01). The authors stated that high-dose irradiation (3 Mrad or more) is unacceptable as it severely affects mechanical properties of the tissue. For larger defects or as salvage procedure, osteochondral cylinder transplantation (OATS or Mosaicplasty) or matrix-induced autologous chondrocyte transplantation (MACT) were recommended. FACS analysis and a tumor necrosis factor-alpha (TNF-) secretion bioassay were used to confirm the lack of immunogenic cells. Autograft versus allograft anterior cruciate ligament reconstruction. Surgical strategies range from repair of cartilage through the formation of fibrocartilage to a variety of restorative procedures, including tissue-engineering-based strategies. A total of 32 patients, mean age of 36.8 +/- 8.4 years, affected by ankle arthritis underwent BFOA with a mean follow-up of 31.2 months. The 2 main drawbacks of this study were its small sample size (n = 10) and short-term follow-up (average of 1.4 years). Weber TR, Wrotslavsky P. A viable osteochondral allograft for articular cartilage replacement of the first metatarsal head. Foot Ankle Spec. The authors noted that while there is abundant literature about osteochondral allograft transplantation in the knee, there are few papers about this procedure in the talus. Ghazavi MT, Pritzker KP, Davis AM, et al. Second, this study was not a prospective/comparative analysis that included partial meniscectomy or conservative treatment. Clinical, radiographic, and histological outcomes after cartilage repair with particulated juvenile articular cartilage: A 2-year prospective study. These allografts can either be fresh or frozen. UpToDate [online serial]. The authors concluded that the long-term results suggested that the technique of Trufit Plug for OLT was safe and demonstrated good post-operative scores including improvement of pain and function, with discordant MRI results. Haene R, Qamirani E, Story RA, et al. While maintaining an intact cartilage structure, the bony portion of Cartiform viable osteochondral allograft is reduced and the graft is porated to offer unique handling characteristics and simple fixation techniques. Oper Orthop Traumatol. They stated that further studies are needed to examine the causes of failure and improve the applicability of this method. Arthroscopy. Fideler and co-workers (1994) concluded that a dose of 30,000 or 40,000 gray (3 or 4 megarad) of gamma radiation is necessary for the inactivation of the DNA of the human immunodeficiency virus in frozen bone-patellar ligament-bone allograft harvested from donors infected with the virus. 2017;33:48-52. The level of evidence of this study was 4. CPT Codes: Common Procedures : 23472: . 2010;26(12):1593-1601. Thus, host MSCs that infiltrate the graft from the underlying bone marrow following marrow stimulation are provided with the optimal micro-environment to undergo chondrogenesis. Drug-eluting stents demonstrated improved patency over bare-metal stents in infra-popliteal arteries (primary patency: 73 % versus 50 % at 1 year), and was at least comparable to balloon angioplasty (66 % primary patency). Face bone graft 21215 Lower jaw bone graft 21230 Rib cartilage graft 21240 Reconstruction of jaw joint 21242 . At 2-year follow-up, the clinical outcome is excellent. The JACI-BMAC group had more patients with hypertrophy exhibited on MRI than the MF group (p = 0.009). Larger lesions showed less improvement in Knee injury and Osteoarthritis Outcome Score (KOOS) (p = 0.04) and SF-36 (p = 0.029). Bucket-handle lesion (p = 0.006) and BMI greater than 25 (p = 0.014) emerged as significant factors of poor prognosis. Health Technology Assessment. Review of mechanical, processing, and immunologic factors associated with outcomes of fresh osteochondral allograft transplantation of the talus. 2008;20(3):188-198. This was a single-case study. Physical knee examinations, as well as multiple clinical surveys and magnetic resonance imaging (MRI) were performed at baseline and 3, 6, 12 and 24 month intervals. While the use of OCA for the treatment of focal osteochondral lesions in the knee is well-established, their use in the treatment of end-stage arthritis is far more controversial. (Level of Evidence: IV). One of the patients with persistent instability also developed chronic regional pain syndrome following surgery. J Bone Joint Surg. Raikin SM. Experimental results using devitalized flash frozen osteochondral allografts revealed the importance of preserving all components of articular cartilage in the CVOCA. Orthop Clin North Am. A statistically significant patient-weighted correlation was found between the CMS and the level of evidence (r = -0.28, p = 0.0072). 3):207-212. Clinical improvement in pain is seen in approximately 75 % to 85 % of people in a number of studies with long-term follow-up. OL OL OL OL OL LI { The CVOCA promoted MSC migration and chondrogenesis following marrow stimulation, improving articular cartilage repair. Both groups produced reparative tissue that exhibited a fibrocartilage composition. border: none; Report of a new technique in combined ligament injuries. /*margin-bottom: 43px;*/ The device is a resorbable tissue regeneration scaffold made predominantly from polylactide-coglycolide copolymer, calcium sulfate, and polyglycolide. At the final follow-up, the Lysholm knee score and Tegner activity level were significantly improved compared to the pre-operative values. Where appropriate, results of comparable studies were pooled. There were no intra-operative or post-operative complications, and there have been no re-operations. C1762 Description Connective tissue, human (includes fascia lata) CPT codes BIO4 may be used in a variety of different orthopaedic procedures. 2001;17(1):9-13. Random-effects meta-analysis was used to pool outcomes across studies. Coding Reference Guide AmnioRepair Allograft is a lyophilized placental membrane allograft that is aseptically processed to preserve the native extracellular matrix and endogenous proteins. They searched the Cochrane Library, Medline, and Embase. Graft selection for anterior cruciate ligament reconstruction:A level I systematic review comparing failure rates and functional outcomes. Bone graft codes are described in CPT as being either morselized or structural. Gorschewsky O, Klakow A, Riechert K, et al. A guidelines panel from the Italian National Guidelines System (Romanini et al, 2010) conducted a critical review of the literature of grafts for arthroscopic ACL reconstruction, andfound that "[a]utograft shows moderate superiority compared with allograft" and that"[a]vailable evidence allows recommendation of use of autograft over allograft in arthroscopic ACL reconstruction." Among the 20 knees (71.4 %) with grafts in-situ, the mean follow-up duration was 9.7 years (range of 1.8 to 30.1). Techniques such as microfracture, and replacement strategies such as autologous osteochondral transplantation, or autologous chondrocyte implantation are the major forms of surgical treatment. Magnetic resonance evaluation of TruFit. Reinhardt KR, Hetsroni I, Marx RG. Pre-operative studies (MRI or previous arthroscopy) reveal absence or near-absence of the meniscus; Significant knee pain unresponsive to conservative treatment. Ng and Bernhard (2018) stated that particulated juvenile allograft cartilage (PJAC) has significant promise and is currently supported by several studies. They stated that additional research is needed to expand the knowledge of and develop guidelines for management of chondral injuries of the hip. J Knee Surg. The purpose of this article was to describe a novel arthroscopic surgical technique for transplantation of juvenile chondrocytes as a treatment for talus OCD defects. The authors concluded that anatomic lateral ankle ligament reconstruction with a semitendinosus allograft for the treatment of CLAI led to high patient satisfaction, decreased pain, a stable ankle without arthritic changes, and significantly improved function. .newText { Cartiform is composed of chondrocytes, chondrogenic growth factors, and extra-cellular matrix proteins that can be implanted through a single-stage procedure. The main drawback of this study was its small sample size (n = 27) and its case-series design; these findings need to be validated in well-designed studies. UpToDate [online serial]. Knee ligament reconstruction with allograft tendons may be performed for the anterior cruciate ligament (ACL), posterior cruciate ligament, medial or lateral collateral ligaments. More functional studies are needed to compare the performance and outcomes of the 2 function-preserving arthroplasties. CPT describes 2 types of bone grafts: allograft (donor bone) and autograft (patient's own bone). Mirzayan R, Sherman B, Chahla J. Cryopreserved, viable osteochondral allograft for the treatment of a full-thickness cartilage defect of the glenoid. 2008;57:563-571. Simon TM, Jackson DW. However, they stated that the long-term effectiveness and the progression of glenohumeral osteoarthritis need to be evaluated. At a mean follow-up of 38 30 months (range of 24 to 107 months), 100 % of patients were completely satisfied with the procedure. Juvenile cartilage allograft tissue implantation (eg, DeNovo NT natural tissue graft, DeNovo ET engineered tissue graft) was developed to treat damaged cartilage. Williams RJ, Gamradt SC. At 9 months, the patient showed complete resolution of pain and improvement in function, and the repair tissue consisted of 85 % hyaline cartilage. MRI was performed pre-operatively and at 12 and 24 months post-operatively. All patients had a minimum 2-year follow-up. Johnson P, Lee DK. Barrett GR, Luber K, Replogle WH, Manley JL. Due in part to successful OCA in other joints, such as the knee and shoulder, OCA has gained popularity as a therapeutic option, especially in the setting of large lesions. All other indications, including aseptic non-union in the upper extremity, dysplasia epiphysealis hemimelica (Trevor's disease), femoral trochlear dysplasia, ilio-tibial band repair, shoulder instability, tarso-metatarsal arthrodesis, repairing chondral defects/lesions of the ankle, elbow, hip, patella, patello-femoral ligament, and shoulder (e.g., acromio-clavicular (AC) separation, Hill Sachs lesions) because its effectiveness has not been established; Synthetic resorbable polymers (e.g., TruFit Plug, PolyGraft) for osteochondral allografts of the knee and other joints; Vascularized bone graft for the treatment of avascular necrosis of the talus. Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts: Sixty cases with 2 years' minimum follow-up. Bone Grafts and Augmentation: I would like help with the cross coding: D6104, D7952, D7953 I have looked at the case studies for all of these codes and the same code seems to be used for all of them.21210 and 21215. Kienbocks disease. Data were collected on the study type, year of publication, number of surgical procedures, mean follow-up, pre-operative and post-operative American Orthopaedic Foot & Ankle Society score, measures used to assess outcome, geography, institution type, and conflict of interest. These researchers collected the clinical and radiographic outcomes of patients who had undergone JACI-BMAC for talar OCLs to assess treatment efficacy and cartilage repair tissue quality using MRI. Patients with an average clinical follow-up of 1.4 years were included in this study; 4 patients were treated solely with OCA plugs for femoral head defects, while the remaining 6 received femoral OCA plugs and at least 1 concomitant procedure for additional intra-articular pathology; 7 patients (70 %) had successful functional outcomes, while 3 (30 %) had unsuccessful outcomes and were subsequently converted to total hip arthroplasty (THA) 5 to 29 months after OCA. padding: 15px; Alternative grafts as synthetic prostheses and allografts must be considered for patients without a suitable autologous graft. Cartiform viable osteochondral allograft is composed of viable chondrocytes, chondrogenic growth factors, and extra-cellular matrix (ECM) proteins. The authors concluded that the findings from the present systematic review of the published studies appeared promising; however, the lack of statistical power and inconsistent documentation made it difficult to determine the superiority of any one intervention compared with another for the treatment of ankle arthritis. The authors concluded that more research is needed to determine which treatment for chondral pathology in the shoulder provides the best long-term outcomes. The reported short-term complication rate was 2.4 %, and the overall failure rate was 18 %. Advances in hip arthroscopy have broadened the spectrum of tools available for diagnosis and management of chondral damage. Int Orthop. They retrospectively examined minimum 12-month follow-up with standard X-rays and clinical outcomes. Adelaar RS, Madrian JR. Avascular necrosis of the talus. Abnormal stability was 5 % for all autografts versus 14 % for all allografts (p < 0.01). Knee. Miller MD, Harner CD. 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