NHS funding and NICE criteria
When ACI is funded on the NHS, why many patients do not qualify, and where the private STACi route fits in.
Yes, but only sometimes. NICE recommends NHS-funded ACI only when all four conditions are met: the cartilage defect is larger than 2 cm², you have had no previous cartilage repair surgery, there is minimal osteoarthritis, and it is carried out at a tertiary referral centre. Many patients miss at least one criterion and look at private options such as STACi.
ACI is available on the NHS in England, but the threshold is deliberately high. The National Institute for Health and Care Excellence (NICE) — the body that decides which treatments the NHS routinely funds — recommends ACI only for a specific group of patients. If you fall inside that group, ACI can be funded. If you fall outside it, even by a single criterion, NHS-funded ACI is usually not offered, and you would be looking at private options or a different NHS procedure. Understanding exactly where the line sits is the difference between months of uncertainty and a clear plan.
NICE Technology Appraisal TA477 sets out the conditions that must all be met for ACI to be recommended on the NHS:
Criteria per NICE Technology Appraisal TA477.
All four met
Eligible for NHS ACi
Any one not met
Consider private STACi
Each criterion, on its own, rules out a real group of patients. The “no previous cartilage repair surgery” condition is a common sticking point: microfracture is often the first operation offered for cartilage damage, so by the time ACI is being considered, many people have already had it — which removes them from NHS-funded ACI for that defect. The “minimal osteoarthritis” condition excludes patients whose joint has already started to show wear, which is common once cartilage damage has been present for a while. And because the defect must be larger than 2 cm² and treated at a tertiary centre, patients with smaller lesions, or those who cannot easily reach a specialist centre, can fall outside the criteria too.
None of this means those patients are untreatable. It means the specific NHS ACI pathway is not open to them, and a different route — a different NHS procedure, or a private option — is needed.
Even for patients who do meet all four criteria, ACI is delivered at only a small number of tertiary referral centres, and it is a two-stage procedure. That combination — few centres, two operations several weeks apart, and cartilage repair sitting alongside more urgent orthopaedic work — means waiting times can be long. For cartilage damage that is painful and progressive, a long wait is not neutral: the joint can deteriorate while you wait, and worsening osteoarthritis can eventually push a patient over the “minimal OA” line and out of eligibility altogether.
Many people look privately precisely because the NHS criteria turned them away — or because the wait was too long for a joint that was getting worse. London Cartilage Clinic offers STACi, the modern single-stage evolution of ACI. It is relevant here for a specific reason: it is designed to treat exactly the larger and more complex damage that the older ACI, and its strict NHS criteria, often exclude, and it is offered for any joint rather than the knee alone. In most cases it is done in a single operation, removing the weeks-long wait between two surgeries.
Being turned down for NHS ACI does not mean nothing can be done. It often means your cartilage damage is larger, more complex, or in a joint the older procedure was never designed for — which is the situation STACi was built to address.
Yes, but only when all four NICE criteria are met: the defect is larger than 2 cm², you have had no previous cartilage repair surgery, there is minimal osteoarthritis, and it is done at a tertiary referral centre. If any one is not met, NHS-funded ACI is usually not offered.
NICE Technology Appraisal TA477 requires a defect larger than 2 cm², no previous cartilage repair surgery on that area, minimal osteoarthritis in the joint, and treatment at a specialist tertiary referral centre. All four must apply together.
The most common reasons are having already had cartilage surgery such as microfracture, or having more than minimal osteoarthritis. A defect smaller than 2 cm² or lack of access to a tertiary centre can also place you outside the criteria. Not qualifying does not mean the damage is untreatable — a different route may suit.
Waits can be long. ACI is offered at only a few tertiary centres, is a two-stage procedure, and sits alongside more urgent orthopaedic work. A long wait matters because the joint can deteriorate, and worsening osteoarthritis can eventually remove eligibility.
Options include a different NHS procedure or a private route. London Cartilage Clinic offers STACi, the modern single-stage evolution of ACI, designed for the larger and more complex damage the NHS criteria often exclude, and offered for any joint. A consultation reviews your imaging and advises the best fit.
STACi is a private procedure at London Cartilage Clinic, from £28,000 all-inclusive. It is not the same as NHS-funded ACI. See the STACi cost guide and the ACI cost UK page.
Still have more specific concerns?
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London Cartilage Clinic
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