1 Recommendations

Guidance

1.1 Evidence on the efficacy of focal resurfacing implants to treat articular cartilage damage in the knee is limited in quality and quantity. Short-term evidence shows no major safety concerns, but long-term evidence on safety is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

1.2 Clinicians wanting to use focal resurfacing implants to treat articular cartilage damage in the knee should:

Inform the clinical governance leads in their healthcare organisation.
Give people (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes, including those in the long term, of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Enter details about everyone having focal resurfacing implants to treat articular cartilage damage in the knee into a suitable registry and review local clinical outcomes.
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

1.3 Healthcare organisations should:

Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.

1.4 Further research should report patient selection, including the site and size of the cartilage damage, and long-term outcomes, including the incidence of revision procedures and joint replacements.

1.5 Patient selection should be done by a multidisciplinary team experienced in managing the condition.

1.6 The procedure should only be done by surgeons experienced in focal articular cartilage resurfacing.

1.7 Report any problems with a medical device using the Medicines and Healthcare products Regulatory Agency's Yellow Card Scheme.