New York State Medical Treatment Guidelines for
Chondral Defects in workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Chondral Defects.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Description and Definition of Chondral Defects

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.

Testing Procedures of Chondral Defects

MRI, Radiographs, CT

MRI, Radiographs, CT are recommended in select patients as clinically indicated.

There are several different kinds of injuries in the knee. The most common is a small bump on the outside of your knee, called a meniscus tear. If you have that kind of injury, an MRI will show up as bone bruising or a small area of missing cartilage.

Non-Operative Treatment

Non-Operative Treatment is recommended In some patients

Rest/restricted activity, crutches or a cane, ice packs, elevation of the legs and bracing can help with pain. Active and/or passive therapy can help as well as NSAIDs if needed. APAP therapeutic injections may also be used at a later date if needed.

Surgical Indications and Operative Treatment of Chondral Defects

The list of pre authorised procedures does not include osteochondral autograft and autologous chondrocyte implantation.

To perform one of these procedures, providers must request pre-authorization from their carriers before beginning the procedure. Refer to Table 3 for criteria.

If non-operative treatment is initially recommended, surgery may be indicated if the patient fails to improve with conservative management. The patient must continue to display the designated objective findings, subjective symptoms, and (where applicable) imaging findings.

Autologous Chondrocyte Implantation (ACI) Exclusion Criteria of Chondral Defects

The ACI procedure is not covered if any of the following apply:

• A lesion of the patellofemoral joint cartilage involves any portion of the articular cartilage, bone, or both. It is a common result of osteochondritis dissecans.

• A kissing lesion, which is a milder form of a modified outerbridge grade II, III, or IV, exists on the opposite tibial surface.

• Joint pain that appears on an x-ray as joint space narrowing, osteophytes, or changes in the underlying bone.

• Unhealthy cartilage border; the synovial membrane may be used as a substitute border for up to ¼ of the total circumference.

• The operation must be performed on both the meniscal cartilage of the affected knee and on at least 1/3 of the posterior meniscal rim.

• Anaphylaxis to gentamicin or sensitivity to bovine products can occur.

• Chondrocalcinosis is diagnosed during the cell culture process. The lab will test your blood and determine whether or not you have a type of bacteria that can cause this condition.

Post-Operative Therapy of Chondral Defects

Depending on the patient’s condition, conservative therapy may include restricted weight-bearing, bracing, active and/or passive therapy. This would include continuous passive movement once microfracture surgery has been performed.

What our office can do if you have workers compensation injuries

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.