The guidelines for treating Chondral Defects have been formulated by the New York State Workers Compensation Board. They aim to aid physicians, and healthcare professionals in determining the right treatment for this condition.
Healthcare professionals dealing with Chondral Defects can rely on these Workers Compensation Board guidelines to make informed decisions about the optimal level of care for their patients.
It’s important to note that these guidelines should not replace clinical judgment or professional expertise. The final decision on care should be a collaborative one, involving the patient and their healthcare provider.
Description/Definition
Cartilage or cartilage and bone defect at the articular or meniscal surface of a joint.
Mechanism of Injury
Usually caused by a traumatic knee injury, particularly as a result of contusion.
Specific Physical Findings
Knee effusion, pain in the joint.
Testing Procedures
MRI, Radiographs, CT
Recommended – in select patients as clinically indicated.
Indications: MRI may reveal bone bruising, osteochondral lesions, or possible articular cartilage injury. Radiographs and CT may also be utilized. Following an acute injury, an MRI typically shows bone bruising.
Non-Operative Treatment
Recommended – in select patients as clinically indicated.
Rest/restricted activity, off-loading with crutches or cane, ice, elevation, bracing, active and/or passive therapy, NSAIDs, APAP therapeutic injections, which may at a late date include hyaluronate therapy.
Surgical Indications / Operative Treatment
Osteochondral Autograft and Autologous Chondrocyte Implantation (ACI) are not included on the list of preauthorized procedures.
Providers who want to perform one of these procedures must request pre-authorization from the carrier before performing the procedure.
If a non-operative treatment approach is initially recommended, surgery may be indicated after the failure of conservative management. The patient must continue to exhibit the designated objective findings, subjective symptoms, and (where applicable) imaging findings.
Autologous Chondrocyte Implantation (ACI) Exclusion Criteria
ACI is not a covered procedure in any of the following circumstances:
i. Lesion that involves any portion of the patellofemoral articular cartilage, bone, or is due to osteochondritis dissecans.
ii. “Kissing lesion” or Modified Outerbridge Grade II, III, or IV exists on the opposite tibial surface.
iii. Mild to severe localized or diffuse arthritic condition that appears on standing x-ray as joint space narrowing, osteophytes, or changes in the underlying bone.
iv. Unhealthy cartilage border; the synovial membrane in the joint may be used as a substitute border for up to ¼ of the total circumference.
v. Prior total meniscectomy of either compartment in the affected knee. Must have at least 1/3 of the posterior meniscal rim.
vi. History of anaphylaxis to gentamycin or sensitivity to materials of bovine origin.
vii. Chondrocalcinosis is diagnosed during the cell culture process.
Modified Outerbridge Classification
I. Articular cartilage softening
II. Chondral fissures or fibrillation < 1.25 cm in diameter
III. Chondral fibrillation > 1.25 cm in diameter (“crabmeat changes”)
IV. Exposed subchondral bone
Post-Operative Therapy
May include restricted weight-bearing, bracing, active and/or passive therapy. Continuous passive movement is suggested after microfracture.
