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Guidelines

Orthopaedic knee procedures

The procedures below do not meet the standards of evidence for us to routinely fund them for our members. These guidelines include summaries of suggested alternatives and how funding decisions are made.

Procedure summaries

Knee arthroscopy

There has been a recommendation against the use of arthroscopy in patients with degenerative knee disease, knee pain or meniscal tear [1,2,3]

Risks associated with an arthroscopy include; deep vein thrombosis, pulmonary embolism, infection, and sometimes death [2]

NICE guidelines recommend that arthroscopic knee washouts should not be used as treatment for osteoarthritis [4]

Arthroscopic lavage and debridement should not be used in osteoarthritis without a clear history of mechanical locking [5]

Platelet-Rich Plasma (PRP) injections

We don’t currently fund claims for PRP injections where evidence does not support its use. This includes cases of osteoarthritis and many tendinopathies.

At our discretion, we may make exceptions if all the following conditions are met:

You’re currently providing PRP for the same indications in your NHS practice routinely

You undertake a sufficient volume of PRP activity

You monitor and receive outcomes on all your patients

You can demonstrate an adequate consent procedure which documents the evidence base, and likelihood of benefit compared to other approaches

ACI and MACI

Autologous Chondrocyte Implantation (ACI) and Matrix-Induced Chondrocyte Implantation (MACI)

There is no conclusive evidence of the benefit of ACI and MACI procedures compared to more established treatments. We consider this treatment to be experimental and unproven at this stage [8, 9]

NICE guidelines recommend ACI as an option in very specific clinical scenarios. These include;

Patients who have not had any surgery to repair articular cartilage defects

Those with minimal osteoarthritic damage to the knee

If the defect is over 2cm2 [10]

Other knee injections

NICE guidelines state that intra-articular corticosteroid injections should be considered as an addition to core treatments of patients with moderate to severe osteoarthritis pain [10]

There’s consistent evidence around the ability of intra-articular corticosteroid injections to provide short-term benefit (up to one week) in patients with osteoarthritis [11, 12]

NICE guidelines do no recommend undertaking Hyaluronic acid injections

Need some help?

If you need further assistance on any of the above procedures, please submit a query form to get in touch with us.

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References

[1] Siemieniuk, R. A., Harris, I. A., Agoritsas, T., Poolman, R. W., Brignardello-Petersen, R., Van de Velde, S., & Helsingen, L. (2017). Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ, 357, j1982.

[2] Thorlund, J. B., Juhl, C. B., Roos, E. M., & Lohmander, L. S. (2015). Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ, 350, h2747.

[3] Abram, S. G., Hopewell, S., Monk, A. P., Bayliss, L. E., Beard, D. J., & Price, A. J. (2019). Arthroscopic partial meniscectomy for meniscal tears of the knee: a systematic review and meta-analysis. British journal of sports medicine, bjsports-2018.

[4] National Institute for Health and Care Excellence (2007). Arthroscopic knee washout, with or without debridement, for the treatment of osteoarthritis. NICE Interventional procedures guidance. Retrieved from: nice.org.uk/guidance/ipg230

[5] Kise N.J, Risberg M.A, Stensrud S, Ranstam J, Roos E.M (2016). Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two-year follow-up. BMJ, 354, i3740

[6] Muchedzi, T. A., & Roberts, S. B. (2018). A systematic review of the effects of platelet rich plasma on outcomes for patients with knee osteoarthritis and following total knee arthroplasty. The Surgeon, 16(4), 250-258.

[7] National Institute for Health and Care Excellence (2007). Platelet-rich plasma injections for knee osteoarthritis. NICE Interventional procedures guidance. Retrieved from: nice.org.uk/guidance/ipg637

[8] Autologous Chondrocyte Implant (ACI). A Systematic Review. Galician Agency for Health Technology Assessment (AVALIA-T, 2009). Retrieved from: http://www.inahta.org/upload/Briefs_10/09160_AVALIA_Autologous_Chondrocyte_Implant_ACI_Systematic_Review.pdf

[9] Autologous Chondrocyte Implantation: Systematic Review. Künzl, M., Wild, C., Mathis, S., & Johansson, T. (2009). Retrieved from: http://eprints.hta.lbg.ac.at/865/

[10] National Institute for Health and Care Excellence (2017). Autologous chondrocyte implantation for treating symptomatic articular cartilage defects of the knee. NICE Interventional procedures guidance. Retrieved from: nice.org.uk/guidance/ta477

[11] Jüni, P., Hari, R., Rutjes, A. W., Fischer, R., Silletta, M. G., Reichenbach, S., & da Costa, B. R. (2015). Intra‐articular corticosteroid for knee osteoarthritis. Cochrane Database of Systematic Reviews, (10).

[12] Glyn-Jones, S., Palmer, A. J. R., Agricola, R., Price, A. J., Vincent, T. L., Weinans, H., & Carr, A. J. (2015). Osteoarthritis. The Lancet, 386(9991), 376-387.

All information accurate as of February 2023

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Orthopaedic knee procedures

Procedure summaries

Knee arthroscopy

Evidence

Funding decision

Platelet-Rich Plasma (PRP) injections

Evidence

Funding decision

ACI and MACI

Evidence

Funding decision

Other knee injections

Evidence

Funding decision

Need some help?

References

Knee arthroscopy

PRP injections

ACI and MACI procedures

Other knee injections

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