Is ACI Available on the NHS? The NICE Criteria, Explained

ACI on the NHS: the honest position

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.

Why many patients don’t qualify

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.

The private route: how STACi fits in

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.