Meniscal allograft transplantation may be considered medically necessary in patients who have had a prior meniscectomy and have symptoms related to the affected side when all of the following criteria are met:
Adult patients should be too young to be considered an appropriate candidate for total knee arthroplasty or other reconstructive knee surgery (eg, <55 years) Disabling knee pain with activity that is refractory to conservative treatment Absence or near absence (>50%) of the meniscus, established by imaging or prior surgery
Documented minimal to absent diffuse degenerative changes in the surrounding articular cartilage (eg, Outerbridge grade II or less, <50% joint space narrowing)
Normal knee biomechanics or alignment and stability achieved concurrently with meniscal transplantation.
Meniscal allograft transplantation may be considered medically necessary when performed in combination, either concurrently or sequentially, with treatment of focal articular cartilage lesions using any of the following procedures:
autologous chondrocyte implantation, or
osteochondral allografting, or
osteochondral autografting.
Use of other meniscal implants incorporating materials such as collagen are considered investigational.
