Please click here to view the full Knee Arthroscopy Commissioning Statement. 

Please click here to access the referral form.

Commissioning Position

NHS Vale of York CCG does NOT routinely commission referral to secondary care for knee arthroscopy.

NB: NHS Vale of York CCG also does NOT routinely commission an elective intervention on patients who have a BMI of 30 or above (classified as obese) or patients who are recorded as a current smoker – see commissioning statement Optimising Outcomes from All Elective Surgery)

In particular, both diagnostic and therapeutic arthroscopy are NOT routinely commissioned:

• for diagnostic purposes for investigation of knee pain
• to provide washout treatment (lavage) or debridement as a treatment for knee pain or arthritis (in line with NICE guidance, this should not be offered as part of a treatment for osteoarthritis unless the person has a clear documented history of mechanical locking)^{2, 3}
• for symptoms of “giving way’ or X-ray evidence of loose bodies without true locking

NB If clinical assessment suggests the patient might have a red flag condition

(e.g.trauma, infection, carcinoma, bony fracture, avascular necrosis, or constant progressive non-mechanical pain, particularly at night), refer without delay OR if there has been knee trauma causing fracture or ligament avulsion and arthroscopy is needed urgently.

The CCG will ONLY commission therapeutic knee arthroscopy in adults where:

• the patient has clear mechanical features of true locking, or symptoms that worsen with conservative treatment,

AND

• conservative treatment has been tried over a 3 month period (This needs to include exercise, weight loss where appropriate, physiotherapy and maximal analgesic medication)

OR

• for patients with chronic knee pain, up to 6 months of comprehensive conservative treatment should be tried, including
  • efforts to lose weight if BMI over 25, (as outlined in NICE guidance³),
  • lifestyle advice, including exercise or rest
  • optimum pharmacological treatments
  • self or physiotherapy guided mobilisation and strengthening exercises.

NB: Referral for MRI scans should only be made by secondary care consultants or specialists working in CCG commissioned MSK services.

Investigation of knee pain with locking within the MSK service (tier 2) should start with less invasive MRI scanning to identify meniscal tears and loose bodies, in line with RSS guidance Radiology for knee pain with locking. The only exception is when there are contraindications to MRI (eg a pacemaker) or diagnostic uncertainty following a MRI scan OR if the patient has an anterior cruciate ligament reconstruction with metal screws affecting the MRI image quality.

Treatment in all other circumstances is not normally funded and should not be referred unless there is prior approval by the Individual Funding Request Panel.

Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes there is an exceptional clinical need that justifies deviation from the rule of this policy. Individual cases will be considered by the individual funding request panel

To submit an application to the CCG's Individual Funding Request Panel, please click here for further information.

Providers will not be reimbursed for procedures on patients that do not have IFR approval.

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