BlueCross and BlueShield of Montana Medical Policy/Codes
Meniscal Allograft Transplantation
Chapter: Surgery: Procedures
Current Effective Date: July 18, 2013
Original Effective Date: March 05, 2010
Publish Date: April 18, 2013
Revised Dates: This policy is no longer scheduled for routine literature review and update. January 18, 2012; October 16, 2012; April 17, 2013
Description

Historically, the role of normal meniscal cartilage was greatly under appreciated, and up until some 30 years ago, torn and damaged menisci were routinely excised.  However, it is now known that the menisci are an integral structural component of the human knee, functioning to absorb shocks, provide joint stability, congruity, and nutrition.  In addition, total and partial meniscectomy are associated with altered load bearing across the joint, frequently resulting in degenerative osteoarthritis.  The integrity of the menisci are particularly important in knees in which the anterior cruciate ligament (ACL) has been damaged; in these situations, the menisci act as secondary stabilizers of anteroposterior and varus-valgus translation.  With this greater understanding, the surgical principles of treating torn or damaged menisci evolved to their repair and preservation whenever possible.  Moreover, meniscal allograft transplantation has been investigated in patients with a previous meniscectomy or for those requiring total or near total meniscectomy for irreparable tears. 

Meniscal allograft transplantation is intended to restore knee function among patients with injured menisci from arthritis or trauma.  The meniscus is a “c” shaped piece of cartilage in the knee.  There are two in each knee; one on the inner and one on the outer side of the joint.  Their purpose is to reduce the amount of friction between the thigh bone (femur) and the shin bone (tibia) and to also help with weight distribution within the knee joint.  Meniscal allograft transplantation is a procedure that attempts to re-establish the function of an absent or badly deteriorating meniscus by transplanting a meniscus cartilage from a donor.  The allograft is transplanted by arthroscopic insertion or via open techniques using an arthrotomy approach.

Meniscal allograft transplantation has been investigated in patients with a previous meniscectomy or who are requiring total or near total meniscectomy for irreparable tears.  There are three general groups of patients who have been treated with meniscal allograft transplantation:

  • young patients with a history of meniscectomy who have symptoms of pain and discomfort associated with early osteoarthrosis that is localized to the meniscus-deficient compartment;
  • those who are undergoing ACL reconstruction in whom a concomitant meniscal transplant is intended to provide increased stability; OR
  • young athletes with few symptoms in whom the allograft transplantation is intended to deter the development of osteoarthritis; due to the risks associated with this surgical procedure, prophylactic treatment is not frequently recommended.

The following different types of allografts have been investigated:

  • Fresh - Fresh implants, harvested under sterile conditions, typically are not a practical option. The grafts must be used within a couple of days to maintain viability.
  • Fresh Frozen - After sterile harvest, the meniscus can be frozen for storage until thawed for use. The freezing process may destroy donor cells and decrease the size of the graft.
  • Freeze Dried (Lyophilized) - In addition to freezing, the tissue may be dehydrated, permitting storage at room temperature. Before transplantation, the graft is thawed and rehydrated.  Lyophilized grafts have been shown to be prone to reduced tensile strength, graft shrinkage, poor rehydration, post-transplantation joint effusion, and synovitis, and are no longer used in the clinical setting.
  • Cryopreserved - Cryopreservation freezes the graft in glycerol, preserving the cell membrane integrity and donor fibrochondrocyte viability.  Cryolife (Marietta, Ga.) is a commercial supplier of such grafts.

In addition, several secondary sterilization techniques have been used, with gamma irradiation being the most common.

Meniscal allograft transplantation has moved into mainstream orthopedics.  With proper patient selection, recognition and treatment of co-morbid conditions, meniscal allograft transplantation offers a solution that can at least temporarily decrease pain and increase function.

Policy

Each benefit plan or contract defines which services are covered, which are excluded, and which are subject to dollar caps or other limits.  Members and their providers have the responsibility for consulting the member's benefit plan or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply.  If there is a discrepancy between a Medical Policy and a member's benefit plan or contract, the benefit plan or contract will govern.

Medically Necessary

BCBSMT may consider meniscal Allograft Transplantation of the knee medically necessary as a treatment for patients with partial (>50%) or complete loss of the meniscus when all of the following criteria are met:

  • The patient has persistent and localized knee pain of at least six months duration that has failed to respond to conservative meniscal treatment; AND
  • The affected joint has ligamentous stability prior to surgery; AND
  • The affected joint has normal alignment without varus or valgus deformities; AND
  • There is no infection, inflammatory arthritis or synovial disease present; AND
  • There is normal articular cartilage (Outerbridge grade II or less) or, if present, articular cartilage abnormalities are treated prior to surgery; AND
  • The adult patient is ≤ 55 years of age and not a candidate for a total knee arthroplasty; OR
  • The adolescent patient is ³ 15 years of age and skeletally mature with documented closure of growth plates; AND
  • The body mass index (BMI) is ≤ 35; AND
  • At least 50% loss of the meniscus must be firmly established by previous operative reports, magnetic resonance imaging (MRI), or diagnostic arthroscopy.

Outerbridge Grading

Grade 0

Normal appearing cartilage

Grade I

Swelling and Softening or Articular Cartilage

Grade II

Fissuring within softened areas

Grade III

Fibrillation

Grade IV

Destruction of articular cartilage and exposed bone

Not Medically Necessary

BCBSMT considers meniscal allograft transplantation of the knee not medically necessary as a treatment for symptomatic patients with partial or complete loss of the meniscus when criteria listed above are not met.

Investigational

BCBSMT considers meniscal allograft transplantation of the knee experimental, investigational and unproven, for the following indications:

  • as a treatment for asymptomatic patients with partial or complete loss of the meniscus OR
  • when performed in combination, either concurrently or sequentially, with autologous chondrocyte implantation (ACI) or osteochondral allografting.

Rationale

Loss of the meniscus either in part or whole, can have a poor prognosis in the long term, with the likelihood of future arthritis thought to be proportional in the amount of tissue that is torn or removed.  There is growing consensus that meniscal allograft transplantation may be indicated in a narrowly defined subset of patients considered too young or active for arthroplasty and who meet specific criteria.  Recent peer-reviewed literature indicates the procedure is useful for carefully selected patients with persistent pain, intact articular cartilage, normal alignment, and a stable knee joint, and may offer the possibility of cartilage protection.  Short and mid-term studies have demonstrated the effectiveness of this procedure in alleviating pain and swelling and in improving knee function.

At the time of a 1997 Blue Cross Blue Shield Association (BCBSA) Technology Evaluation Center TEC Assessment, data regarding meniscal allograft transplantation were of poor quality.   For example, none of the studies presented clear comparisons of preoperative findings to postoperative results, and each study assessed outcomes differently. While definitive data were not available, poor results were reported in patients with Outerbridge grade III or IV osteoarthritis, or in those with unstable knees.

Although clinical experience has helped define indications for meniscal allograft transplantation, at this time there is still limited information on the long term results of this procedure as well as other factors that impact outcomes.  These include: the challenge in early detection of the onset of joint degeneration in patients who are known to be meniscus-deficient; lack of information on the biology of the transplanted meniscus including the process of cell migration into the meniscus during cellular re-population and the effect of an immune response on graft remodeling; and lack of information to guide rehabilitation after meniscal transplantation.

In terms of graft viability, the largest case series has been collected by CryoLife, a commercial supplier of cryopreserved allografts.  However, these data are not available in the published peer-reviewed literature.  As summarized by Johnson in a 1999 report, among 1,023 transplants, CryoLife reported graft survival of 93% when the meniscus is transplanted with a bone plug for fixation, compared to 67% without such fixation.  The method of determining graft viability, with either serial MRI scans or second-look arthroscopy, was not reported.  

Contraindications for meniscal transplantation include those with a systemic metabolic degenerative disease, arthritis of the knees, flattening of the femoral condyles or severe degenerative changes (greater than 50% joint space narrowing, bone on bone, or erosion to subchondral bone).  Meniscal transplantation is not indicated for patients who have undergone partial or total meniscectomy and do not have symptoms or problems with their knee.  It is evident that meniscal allograft transplantation is a viable option for the treatment of symptomatic patients provided rigid inclusion criteria are met.  Patients with appropriate indications should expect to do well postoperatively in terms of a predictable reduction in pain and an ability to increase activity levels.  Only further study will clarify the long-term results of meniscal allografts as well as their role in preventing the progression of secondary osteoarthritis in the involved compartment.

Thirty-two patients were followed by Sekiya, et al. to determine the clinical outcomes following isolated lateral meniscal allograft transplantation.  The results suggested that isolated meniscal allograft transplantation can be a beneficial procedure in properly selected symptomatic patients with a lateral meniscus-deficient knee.  The data also suggested that earlier meniscal transplantation, before the onset of significant joint space narrowing, may result in improved outcomes.  Finally, bony fixation may have a significant advantage over suture fixation, particularly with regard to knee range of motion.  

Verdun, et al. published a study of procedures involving transplantation of viable medial and lateral meniscal allografts performed in 96 patients.  Thirty-nine medial and 61 lateral meniscal allografts were evaluated after a mean of 7.2 years.  The authors concluded that transplantation of a viable meniscal allograft can significantly relieve pain and improve function of the knee joint.  Survival analysis showed that this beneficial effect remained in approximately 70% of the patients at ten years.  This study identified the need for a prospective study comparing patients with similar symptoms and clinical findings treated with and without a meniscal allograft and followed for a longer period of use of clinical evaluation as well as more objective  documentation tools regarding the actual fate of the allograft itself and the articular cartilage.

Cole, et al. conducted a study of 44 meniscus transplants in 39 patients which were evaluated at minimum 2-year follow-up using the Lysholm, Tegner International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Noyes symptom rating and sports activity, and SF-12 scoring systems; visual analog pain scales; patient satisfaction; and physical examination.  Four transplants failed early, leaving 40 patients in 36 patients for review.  Patients were grouped into medial and lateral transplant groups as well as those with isolated and combined procedures.  Twenty-one menisci were transplanted in isolation (52.5%), and 19 were combined with other procedures (47.5%) to address concomitant articular cartilage injury.  Patients demonstrated statistically significant improvements in standardized outcomes surveys and visual analog pain and satisfaction scores.  In seven patients, treatment had failed at final follow-up.  Overall, 77.5% of patients reported they were completely or mostly satisfied with the procedure, and 90% of patients were classified as normal or nearly normal using the International Knee Documentation Committee knee examination score at final follow-up.  There were no significant differences in the medial and lateral subgroups, although the lateral subgroup did demonstrate a trend toward greater improvement.  No significant differences were noted in the isolated and combined subgroups.  The authors concluded that meniscus transplantation alone or in combination with other reconstructive procedures results in reliable improvements in knee pain and function at minimum 2-year follow-up.  Longer term studies are necessary to determine if transplantation can prevent the articular degeneration associated with meniscectomy.

2009 Update

A search of the MedLine database for the period through July 2009 identified a number of retrospective case series with isolated meniscal allograft.

In a case study of 23 patients, Rath and colleagues reported significant improvement in function and reduced pain as measured by the Short Form-36 scores after cryopreserved meniscal allograft transplantation for compartmental pain after total meniscectomy two- to eight-years postoperatively.  However, the authors noted function remained limited, and eight of 22 allografts tore during the study period and required total or partial meniscectomies.  In a prospective study of 23 patients who underwent medial meniscal transplantation with reconstruction of the ACL, Wirth and colleagues reported better results in the six cases of preservation of deep-frozen allografts over lyophilized meniscal transplants at three and 14 years postoperatively.  However, no preoperative clinical outcomes were assessed.  Noyes and colleagues reported on 38 patients receiving cryopreserved meniscal transplant.  At a mean of 40 months postoperative follow-up, 27 (68%) and 13 (33%) patients had no pain or mild pain, respectively, and the meniscal grafts appeared normal in 17 knees (43%) but failed in 11 (28%) knees and were altered in 12 (30%).  Interpretation of these results is limited since 16 knees also received concomitant osteochondral autograft transfer, and nine had knee ligament reconstruction.  The authors of this study noted further investigation is required to determine long-term transplant function and any chondroprotective effects.

Verdonk and colleagues reported long-term follow-up from 95% of their first 105 fresh cultured (viable) meniscal allografts performed from 1989–2001.  The indication for transplantation was moderate-to-severe pain in a younger patient (mean of 35 years, range 16 to 50 years old) who had undergone a previous total meniscectomy, was not old enough to be considered for a knee joint replacement, and had good alignment of the lower limb and a stable joint (some were corrected concomitantly).  Postoperative clinical evaluation was conducted yearly; two subjects were lost to follow-up as a result of death unrelated to the transplant (these were carried forward).  With failure defined as moderate or severe pain (occasional or persistent) or poor knee function (modified Hospital for Special Surgery score of less than 80), 70% of the viable allografts (39 medial, 61 lateral) survived at 10 years, the mean survival time was estimated at 11.6 years.

This group also published follow-up of at least 10 years with radiological imaging from their first 42 allografts (27 medial, 15 lateral, treated from 1989 to 1993).  Of the 41 patients, 7 (17%) were followed up at the time of total knee replacement (failures); these were characterized by progression in joint space width narrowing (by 1 or 2 grades) and Fairbank changes (by 1 or 2 grades).  Twenty-five allografts were evaluated in 2004 (average of 12 years follow-up).  Of the 32 cases evaluated (76% follow-up), joint space remained stable in 41% and Fairbank changes did not progress in 28%.  MRI showed absence of further femoral cartilage degeneration in eight of 17 knees (47%) evaluated.  No significant correlations were found between any of the measured radiological or MRI parameters clinical subscales.  The investigators of these reports discuss the investigational nature of this procedure and suggest a need for a prospective long-term comparison (using both subjective and objective clinical outcome measures) of patients who are treated with a meniscal allograft and a control group of patients who have similar symptoms and clinical findings.

Heckman and colleagues conclude in their review that, “For patients in whom meniscus function has been lost from prior meniscectomy, the short-term results of meniscus transplantation are encouraging, as many patients demonstrate improvement in knee function and pain relief in the affected compartment.  However, the long-term function of this operation remains questionable, as the transplant appears to undergo remodeling, which results in alterations in collagen fiber architecture required for load-sharing and survival.”  Eriksson also notes that although meniscus transplantation holds promise for the younger patient, transplant procedures are evolving.

Matava conducted a systematic review of the available literature; none of the 15 studies identified could be classified as Level I or Level II (prospective controlled comparisons), three studies qualified as Level III (retrospective comparisons); the 12 remaining studies were retrospective case series.  The primary indication for meniscal allograft transplantation in these studies was complete or near-complete meniscectomy with pain in the involved compartment, and before the development of moderate to severe arthrosis (less than two to three mm of joint space narrowing and/or limited chondral wear) in a young (less than 50 years of age) active patient.  Lower extremity malalignment and/or ligamentous instability have been associated with meniscal transplantation failure, and thus were treated (e.g., osteotomy or ACL repair) before or at the time of the transplantation.  Twelve studies used validated outcome measures, with second-look arthroscopy conducted in some of the patients in 11 studies.  “Success” rates were usually over 60% (ranging from 13% to 100%), with more recent series reporting short-term favorable outcomes (based on pain, function, and patient satisfaction) in about 85% of their patient cohorts (generally 20 to 30 patients per cohort).  Up to 26% reoperation rates for allograft tears in addition to other complications were reported.  Matava et al noted that fresh frozen or cryopreserved grafts were associated with the highest success rates and the least risk for biomechanical degradation or disease transmission.

Hommen et al. reported 10-year follow-up on 20 of 22 (91%) consecutive patients who received cryopreserved meniscus allografts.  Twenty-four concomitant procedures were performed in 15 of the patients, including ACL reconstruction or revision (n=10), high tibial osteotomy (n=2), and lateral retinaculum release (n=3).  Forty additional surgical procedures were performed on 17 patients (85%) after transplantation; these included manipulation under anesthesia, arthroscopic synovectomy for postoperative arthrofibrosis, and additional meniscus-related procedures.  The 10-year graft survival/success rate was 45%, with five allograft failures identified on second-look surgery, five allografts with grade III tears identified on MRI, and four patients reporting no improvement.  Of 15 patients with follow-up radiographs, 10 (67%) had narrowing (from 5.2 mm at baseline to 4.0 mm at follow-up) and 12 (80%) had progression of the Fairbank degenerative joint disease score (0.5 at baseline to 1.3 at follow-up) in the transplanted tibiofemoral compartment.  Twenty-year follow-up was reported for five patients who had received a deep frozen meniscal allograft along with other procedures on the knee.  At 20-year follow-up MRI revealed shrinkage of the transplants with very small rims of the meniscus; the remaining meniscal tissue showed degenerative changes.  The average Lysholm score at 20-year follow-up was 74 points (individual scores of 97, 95, 88, 70, and 21).  As noted by Hommen et al, questions remain about whether meniscus grafts can delay or prevent the progression of degenerative changes and joint space narrowing.

Combined meniscus transplantation and articular cartilage repair has been recently reported.  Farr et al described outcomes from a prospective series of 36 patients who underwent ACI together with meniscal transplantation.  Four patients (11%) were considered failures before two-years, and three were lost to follow-up (8%), resulting in 29 evaluable patients at an average of 4.5 years after surgery.  The Lysholm score improved from an average score of 58 to 78; maximum pain decreased an average 33% (from 7.6 to 5.1).  Excluding the four failures, 68% of their patients required additional surgeries; 52% had one additional surgery, and 16% required two or more additional surgeries.  The most common procedures were trimming of periosteal overgrowth or degenerative rims of the transplanted meniscus.  Another report described average 3.1 years of follow-up from a prospective series of 30 patients (31 procedures) who had undergone combined meniscal allograft transplantation with ACI (52%) or osteochondral allograft transplantation (OA; 48%).  The Lysholm score improved in both the ACI (from 55 to 79) and OA (from 42 to 68) groups; 48% of patients (60% ACI and 36% OA) were considered to be normal or nearly normal at the latest follow-up.  Patients treated with OA were on average older (average 37 vs. 23 years) and with larger lesions (5.5 cm2 vs. 3.9 cm2).  Two patients were considered failures (7%) and five (17%) underwent subsequent surgery. Although results seem promising, evidence is currently insufficient to permit conclusions regarding the effect of combined transplantation-implantation procedures on health outcomes.

Meniscal allograft transplantation is associated with a high number of complications, including tears of the transplanted meniscus, displacement, or arthrofibrosis, and careful selection of patients and surgical technique appear to be critical for success of this procedure.  For example, one review concludes that success depends on performing the procedure with appropriate indications, using appropriate-sized menisci and meticulous technique.  Another states that “patients who meet criteria for meniscus allograft but have instability, malalignment or focal cartilage defects, may be candidates for transplantation as well as procedures to correct associated pathology. Such major interventions must, at present, be considered salvage procedures, and we do not recommend that they be performed casually or by surgeons without extensive experience and expertise in complex knee reconstruction.”

In summary, meniscal allograft transplantation, performed in combination with other surgical interventions, appears to improve symptoms in some patients with a prior meniscectomy who are considered too young to undergo total knee replacement.  Evidence consisting primarily of retrospective case series indicates that this procedure may produce short to intermediate-term pain relief in selected patients.  The literature does not permit conclusions concerning the effect of meniscal transplantation on the progression of degenerative changes and joint space narrowing.

Coding

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.

ICD-9 Codes

80.16, 80.26, 81.4, 81.43, 81.45, 81.46, 81.47

ICD-10 Codes
M23.000-M23.92, S83.200-S83.289, S83.30-S83.32
Procedural Codes: 29868
References
  1. Meniscal Allograft Transplantations.  Chicago, Illinois:  Blue Cross Blue Shield Association – Technology Evaluation Assessment Program (1997 August) 12(14):1-7.
  2. Johnson, D.L., and D. Bealle.  Meniscal allograft transplantation.  Clinical Sports Medicine (1999 January) 18(1):93-108.
  3. Stollsteimer, G.T., Shelton, W.R., et al.  Meniscal allograft transplantation: a 1- to 5-year follow-up of 22 patients.  Arthroscopy (2000 May-June) 16(4):343-7.
  4. Peterson, R.K., Shelton, W.R., et al.  Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction:  A 5-year follow-up.  Arthroscopy (2001 January) 17(1):9-13. 
  5. Rath, E., Richmond, J.C., et al.  Meniscal allograft transplantation.  Two- to eight-year results. American Journal of Sports Medicine (2001 July-August) 29(4):410-4.
  6. Wirth, C.J., Peters, G., et al.  Long-term results of meniscal allograft transplantation.  American Journal of Sports Medicine (2002 March-April) 30(2):174-81.
  7. Ryu, R.K., Dunbar, V. W., et al.  Meniscal allograft replacement:  a 1-year to 6-year experience.  Arthroscopy (2002 November-December) 18(9):989-94.
  8. Felix, N.A., and L.E. Paulos.  Current status of meniscal transplantation.  Knee (2003 March) 10(1):13-17.
  9. Sekiya, J.K., Giffin, J.R., et al.  Clinical outcomes after combined meniscal allograft transplantation and anterior cruciate ligament reconstruction.  American Journal of Sports Medicine (2003 November-December) 31(6):896-906.
  10. Yoldas, E.A., Sekiya, J.K., et al.  Arthroscopically assisted meniscal allograft transplantation with and without combined anterior cruciate ligament reconstruction.  Knee Surgery,  Sports Traumatology, Arthroscopy) (2003 May) 11(3):173-82.
  11. Graf, K.W., Seklya, J.K., et al.  Long-term results after combined medial meniscal allograft transplantation and anterior cruciate ligament reconstruction:  Minimum 8.5-year follow-up study Arthroscopy (2004 February) 20(2):129-40.
  12. Noyes, F.R., Barber-Westin, S.D., et al.  Meniscal transplantation in symptomatic patients less than fifty years old.  Journal of Bone and Joint Surgery American (2004 July) 86-A (7):1392-404.
  13. Rijk, P.C.  Meniscal allograft transplantation—Part I:  background results, graft selection and preservation, and surgical considerations.  Arthroscopy (2004 September) 20(7):728-43.
  14. Rijk, P.C.  Meniscal allograft transplantation—Part II:  alternative treatments, effects on articular cartilage, and future directions.  Arthroscopy (2004 October) 20(8):851-9.
  15. Caldwell, P.E., and W.R. Shelton.  Indications for allografts.  Orthopedic Clinics of North America (2005 October) 36(4):459-67.
  16. Noyes, F.R., Barber-Westin, S.D., et al.  Meniscal transplantation in symptomatic patients less than fifty years old.  Journal of Bone and Joint Surgery American (2005 September) 87 Supplement 1(part 2):149-65.
  17. Verdonk, P.C., Demurie, A., et al.  Transplantation of viable meniscal allograft.  Survivorship analysis and clinical outcome of one hundred cases.  Journal of Bone and Joint Surgery.  American Volume (2005 April) 87(4):715-24.
  18. Caldwell, P.E., and W.R. Shelton.  Indications for allografts.  Orthopedic Clinics of North America (2005 October) 36(4):459-67.
  19. Alford, W., and B.J. Cole.  The indications and technique for meniscal transplant.  Orthopedic Clinics of North America (2005 October) 36(4):469-84.
  20. Scopp, J.M., and B.R. Mandelbaum.  A treatment algorithm for the management of articular cartilage defects.  Orthopedic Clinics of North America (2005 October) 36(4):419-26.
  21. Noyes, F.R., Barber-Westin, S.D., et al.  Meniscal transplantation in symptomatic patients less than fifty years old.  Journal of Bone and Joint Surgery American (2005 September) 87 Supplement 1(Pt 2):149-65.
  22. Meniscal Allograft Transplantation.  Chicago, Illinois:  Blue Cross Blue Shield Association Medical Policy Reference Manual (2006 January) Surgery 7.01.15.
  23. Sekiya, J.K., and C.I. Ellingson.  Meniscal allograft transplantation.  Journal of the American Academy of Orthopedic Surgery (2006 March) 14(3):164-74.
  24. Verdonk, P.C., Demurie, A., et al.  Transplantation of viable meniscal allograft.  Surgical Technique.  Journal of Bone and Joint Surgery, American Volume (2006 March) 88 (Supplement 1 Part. 1):109-18.
  25. Cole, B.J., Dennis, M.G., et al.  Prospective evaluation of allograft meniscus transplantation: a minumum 2-year follow-up.  American Journal of Sports Medicine (2006 June) 34(6):919-27.
  26. Sekiya, J.K., West, R.V., et al.  Clinical outcomes following isolated lateral meniscal allograft transplantation.  Arthroscopy (2006 July) 22(7):771-80.
  27. Verdonk, P.C., Verstraete, K.L., et al.  Meniscal allograft transplantation:  long-term clinical results with radiological and magnetic resonance imaging correlations.  Knee Surgery, Sports Traumatology, Arthroscopy (2006 August) 14(8):694-706.
  28. Heckmann, T.P., Barber-Westin, S.D., et al.  Meniscal repair and transplantation: indications, techniques, rehabilitation, and clinical outcome.  Journal of Orthopaedica and Sports Physical Therapy (2006 October) 36(10):795-814.
  29. Matava, M.J.  Mensical allograft transplantation: a systematic review.  Clinical Orthopaedics and Related Research (2007 February) 455:142-57.
  30. McCulloch, P.C., Kang, R.W., et al.  Prospective evaluation of prolonged fresh osteochondral allograft transplantation of the femoral condyle:  minimum 2-year follow-up.  American Journal of Sports Medicine (2007 March) 35(3):411-20.
  31. Hommen, J.P., Applegate, G.R., et al.  Meniscus allograft transplantation: ten-year results of cryopreserved allografts.  Arthroscopy (2007 April) 23(4):388-93.
  32. Lubowitz, J.H., Verdonk, P.C., et al.  Meniscus allograft transplantation: a current concepts review.  Knee Surgery, Sports Traumatology, Arthroscopy (2007 May) 15(5):476-92.
  33. Farr, J.,  Rawal, A., et al.  Concomitant meniscal allograft transplantation and autologous chondrocyte implantation: minimum 2-year follow-up.  American Journal of Sports Medicine (2007 September) 35(9):1459-66.
  34. von Lewinski, G., Milachowski, K.A., et al.  Twenty-year results of combined meniscal allograft transplantation, anterior cruciate ligament reconstruction and advancement of the medical collateral ligament.  Knee Surgery, Sports Traumatology, Arthroscopy (2007 September) 15(9):1072-82.
  35. Rue, J.P., Yanke, A.B., et al.  Prospective evaluation of concurrent meniscus transplantation and articular cartilage repair:  minimum 2-year follow-up.  American Journal of Sports Medicine (2008 September) 36(9):1770-8.
  36. Meniscal Allograft Transplantation.  Chicago, Illinois:  Blue Cross Blue Shield Association Medical Policy Reference Manual (2008 November) Surgery 7.01.15.
History
December 2011 Policy reviewed: updated policy statement and medical necessity criteria, rationale, and references. Name change fromMeniscal Allograft Transplantation to Meniscal Allograft and Collagen Meniscus Implants
October 2012 Policy updated with literature review through December 2011; Rationale section revised; reference 17 added and references reordered; some references removed; policy statements unchanged
April 2013 Title changed from "Meniscal Allograft and Collagen Meniscus Implants" to "Meniscal Allograft Transplantation".  Criteria added to Medically Necessary statement.  Added a Not Medically Necessary statement.  Rationale revised.  Removed HCPCs code G0428.
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Meniscal Allograft Transplantation