Knee Arthroscopy

To diagnose and treat knee joint problems

Threshold

1. The following procedures* will be funded if mechanical symptoms with or without effusion are present following X-Ray/MRI
   • Meniscal Surgery
   • Repair of cruciate ligament
   • Synovectomy, synovial biopsy
   • Assessment of articular surfaces, prior to osteotomy, partial replacement/athroplasty
   • Osteochondritis dissecans
2. There is no evidence for the use of arthroscopy for the primary investigation of knee pain. MRI should be used first if appropriate**.
3. Arthroscopy is not indicated in the management of advanced degenerative disease, Chondromalacia patella or by the presence of Synovial Plica.
4. Arthroscopic lavage and debridement as part of treatment for osteoarthritis is not indicated, unless the person has knee osteoarthritis with a clear history of mechanical locking (as opposed to morning joint stiffness, ‘giving way’ or X-ray evidence of loose bodies) (NICE, 2014).

*Patients within the acute setting who need immediate treatment e.g. following meniscal and chondral injury are exempt from this policy.

**Indications for Knee MRI: Investigation of knee pain in patients under 50 years of age (unless clinical concern of tumour); plain x-rays should be carried out first in patients over the age of 50 (MRI over diagnoses meniscal pathology in this group)

Cases for Individual Funding Consideration (Patients who do not meet policy criteria)

On a case to case basis, patients might be eligible for surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.