Single-step scaffold insertion for repairing symptomatic chondral knee defects

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 12 sources, which was discussed by the committee. The evidence included 5 systematic reviews and meta-analyses, a systematic review and network meta-analysis, 4 randomised controlled trials, a 5‑year follow-up analysis of a randomised controlled trial and a registry study. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: improved quality of life and mobility, and reduced pain.

The professional experts and the committee considered the key safety outcomes to be: pain, bleeding, infection and failure to improve symptoms.

Patient commentary was sought but none was received.

The committee was informed that:

• This procedure can be done by a trained orthopaedic knee surgeon in a general hospital, but more complex defects may need to be referred to a regional specialist centre.

• Like other procedures for chondral knee defects, after the surgery, a rehabilitation programme needs to be followed.

• Different technologies can be used to do this procedure, and they have different amounts of evidence.

The committee noted that:

• A variety of scaffolds can be used in this procedure. Some, but not all, contain animal products.

• Techniques for introducing the cells that grow into new cartilage are evolving.