Autologous Chondrocyte Implantation

Aetna covers autologous chondrocyte implantation for repair of full‑thickness, focal chondral defects of the knee causing disabling pain in patients ≥15 years with documented growth plate closure or adults <55, BMI ≤35, who can comply with post‑op weight‑bearing/activity restrictions and rehabilitation and who have failed conservative therapy including ≥2 months of physical therapy. It is considered experimental/investigational (and thus excluded) for talar/other‑joint lesions (ankle, hip, shoulder), prior total meniscectomy, defects associated with osteoarthritis/inflammatory arthritides, patients with gentamicin anaphylaxis or bovine material sensitivity, and when used as initial/first‑line surgical therapy.

"Aetna considers autologous chondrocyte implants medically necessary for repairing cartilage defects of the knee in members who have symptoms of disabling knee pain related to a full thickness, foca..."