Description:

Autologous chondrocyte implantation was developed for the treatment of traumatic cartilage defects in an attempt to prevent or delay total knee replacement. Autologous chondrocyte implantations is a procedure in which healthy chondrocytes are harvested, expanded ex-vivo, and then reimplanted into the body. The cells are isolated from patient’s cartilage biopsy taken from non-load-bearing regions of the knee, expanded in culture, and seeded onto the collagen membrane. An arthrotomy is performed and the chondral lesion is excised up to the normal surrounding cartilage. The cultured chondrocytes on the collagen scaffold are then placed to cover the lesion. The injected cells then grow to form a hard cartilage tissue in 9 to 12 months. Literature reveals that chondrocyte grafts may be beneficial for selected patients with severe but limited focal articular cartilage defects. Carefully selected patients may benefit in the short to medium term. It is not a suggested treatment for patients with osteoarthritis.

Clinical Criteria:

(Indications/Limitations)

I. Autologous chondrocyte implants are considered medically necessary for members with symptoms of disabling knee pain related to a full thickness, focal defect in the articular cartilage knee when ALL the following criteria are met:

• A. Skeletally mature adults <60 years of age; and
• B. Body mass index (BMI) less than or equal to 35; and
• C. Cooperative person for post-operative weight bearing restrictions and activity restrictions together with a potential for completion of post-operative rehabilitation; and
• D. Failure of at least 2 months of conservative therapy; and
• E. Informed consent with realistic expectations; and
• F. No active inflammatory or other arthritis, clinically and by X-ray; and
• G. Presence of disabling pain and/or knee locking; and
• H. Procedure is not being done for treatment of degenerative arthritis (osteoarthritis); and
• I. Stable knee with intact meniscus and normal joint space on X-ray, and
• J. Absence of osteochondritis dessecans

II. Contraindications for MACI:

• A. Severe osteoarthritis of the knee.
• B. Inflammatory arthritis, inflammatory joint disease, or uncorrected congenital blood coagulation disorders.
• C. Prior knee surgery (within 6 months), excluding surgery to procure a biopsy or a concomitant procedure to prepare the knee for a MACI implant.

Limitations:

Autologous chondrocyte implants are considered experimental and investigational for talar lesions or lesions of other joints (e.g., hip and shoulder) and all other indications because the effectiveness of autologous chondrocyte implants for these lesions has not been established.