Concierge orthopaedics · United Kingdom
Knee preservation surgery, to delay the knee replacement.
A joint-preserving operation by a consultant knee surgeon — meniscal repair, ACL, MACI cartilage repair, osteotomy or a bone-sparing partial replacement — for young, active adults whose knee is not yet ready to be swapped out.
Why patients choose us
- 01
Preserve the joint you were born with
A named consultant knee surgeon whose day job is joint preservation — not a general orthopod who occasionally fixes a meniscus.
- 02
Every option on the table before arthroplasty
Repair beats resection. Osteotomy beats replacement. We say so before you sign for a knee replacement you may not need for another decade.
- 03
Independent, and free
We are paid by no clinic and no surgeon, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private knee preservation surgery costs in the UK.
Indicative ranges across our UK partner clinics. Send the details and we quote firm figures across two or three options — usually a repair, a reconstruction and an alignment approach.
In short
Meniscal repair in our network: £5,500–£9,000, day case, and the meniscus stays in your knee.
| Procedure | Indicative range | Typical duration | Stay |
|---|---|---|---|
| Knee arthroscopy ± meniscal work | £4,000–£8,000 | 45–90 min | Day case |
| Meniscal repair (all-inside) | £5,500–£9,000 | 60–90 min | Day case |
| Meniscal allograft transplantation (MAT) | £12,000–£18,000 | 2–3 hours | 1–2 nights |
| ACL reconstruction ± InternalBrace / ALL | £8,000–£14,000 | 90–120 min | Day case / 1 night |
| MPFL reconstruction (kneecap stabilisation) | £7,000–£11,000 | 90 min | Day case |
| Multi-ligament reconstruction (PCL/PLC) | £12,000–£20,000 | 3–4 hours | 2–3 nights |
| MACI cartilage repair (2-stage) | £16,000–£28,000 | 2 procedures | 1 night stage 2 |
| OATS / osteochondral autograft | £8,000–£14,000 | 90 min | Day case / 1 night |
| High tibial osteotomy (HTO) | £10,000–£14,000 | 2 hours | 1–2 nights |
| Distal femoral osteotomy (DFO) | £11,000–£15,000 | 2 hours | 1–2 nights |
| Tibial tubercle transfer / osteotomy | £8,000–£12,000 | 90 min | Day case / 1 night |
| Patellofemoral joint replacement | £12,000–£18,000 | 90 min | 1–2 nights |
| Unicompartmental knee replacement (UKA) | £13,000–£20,000 | 90 min | 1–2 nights |
| Consultation with knee-preservation surgeon | £250–£450 | 45 min | Same visit |
Prices vary by clinic, by the surgeon, by which grafts or implants are used, and by whether combined procedures (an ACL with an ALL, or an HTO with cartilage repair) are done together. We come back with a firm quote within one working day.
The problem
The wrong knee, in the wrong hands, gets the wrong operation.
Too many young knees are booked for a replacement when a repair, a reconstruction or a realignment would have kept the joint for another 15 years. And too many tight meniscal repairs are done as meniscectomies because it is quicker.
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Too young for a replacement?
Under 55 with correctable pathology, meniscal repair, cartilage repair or an osteotomy usually beats a total knee.
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Meniscal tear on MRI?
A peripheral vertical tear in a young knee is a repair, not a resection. We say so before you sign the consent.
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Told you need a knee replacement?
A second opinion from a knee-preservation surgeon is worth having — often the joint has more mileage in it than you were told.
The journey
From enquiry to rehabilitation — what happens, in order.
One consultant knee surgeon from first message through to your six-week and six-month review — with specialist physio joined-up throughout.
Phase 1 · Before your surgery
Concierge, off-stage for you
Phase 2 · On the day
A few hours to a night at the clinic
Phase 3 · After
Rehab, joined-up
- 01
Before
You tell us what is going on
A short, confidential form. Symptoms, previous imaging, whether the knee gives way, catches, swells or hurts on the inside or outside.
- 02
Before
We come back with a recommendation
Within one working day: the right surgeon, whether an MRI or long-leg alignment view is needed first, and an indicative price for the likely procedure.
- 03
Before
We arrange consultation and imaging
Usually within one to two weeks. Existing MRIs are reviewed; long-leg standing X-rays are requested if osteotomy is on the table.
- 04
On the day
Surgery day at the clinic
Arrival, consent and a chat with the surgeon and anaesthetist. Regional block plus GA for most cases; single-shot spinal for shorter procedures.
- 05
On the day
The procedure itself
From a 45-minute arthroscopic meniscal repair to a 3-hour combined osteotomy and cartilage repair — all in a proper orthopaedic theatre.
- 06
On the day
Same-day or overnight stay
Arthroscopy is day-case; osteotomy and multi-ligament reconstruction usually one to two nights. Crutches and a knee brace as required.
- 07
After
Rehabilitation with a knee physio
Specialist knee physiotherapy from week one. Return to sport ranges from 6 weeks (simple arthroscopy) to 9–12 months (ACL, osteotomy, cartilage).
Typical end-to-end: 2–4 weeks from enquiry to surgery. Return to sport: 6 weeks to 12 months depending on the procedure.
When it helps
When joint preservation is the right step.
The situations we see most, plus the one red flag that means today, not next month.
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Painful meniscal tear in a young knee
A vertical peripheral tear in the vascular zone — a repair, not a resection, preserves long-term function.
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ACL rupture in a pivoting athlete
A torn ACL in a footballer, skier or netball player — reconstruction with graft ± InternalBrace or ALL augmentation.
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Kneecap that dislocates
Recurrent patellar instability — MPFL reconstruction, sometimes with trochlear or tibial tubercle work.
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Focal cartilage defect
A discrete cartilage lesion on MRI in an otherwise healthy joint — microfracture, OATS or MACI, not a replacement.
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Bow-legged with medial-side pain
Varus knee with isolated medial-compartment wear — a high tibial osteotomy offloads the joint and delays replacement.
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Knock-kneed with lateral-side pain
Valgus knee with lateral-compartment wear — a distal femoral osteotomy realigns the limb and preserves the joint.
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Isolated single-compartment OA
One compartment worn, the rest intact — unicompartmental replacement or osteotomy, not a full knee replacement.
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Red flag: locked knee
A knee stuck bent, unable to straighten fully — a displaced bucket-handle meniscal tear needs urgent arthroscopy, not a waiting list.
The joint-preservation spectrum
Every joint-sparing option, in one place.
Meniscus, ligament, cartilage, alignment, kneecap and single-compartment surfaces — the full spectrum of what preserves the joint you were born with.
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Knee arthroscopy
Keyhole surgery for meniscal repair, chondroplasty, loose body removal and diagnostic look. See /treatments/knee-arthroscopy.
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Meniscal repair
All-inside (FasT-Fix, OMNI), inside-out or outside-in sutures for peripheral vertical tears in the vascular zone — preserves meniscal function.
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Partial meniscectomy
Removal of the torn portion when repair is not possible. Not recommended for degenerative OA-related tears (NICE NG226).
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Meniscal allograft transplantation
MAT for the young post-meniscectomy painful knee — specialist centres only. NICE-supportive via IPG guidance.
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ACL reconstruction
Hamstring, BPTB or quadriceps tendon autograft ± InternalBrace augmentation. See /treatments/internal-brace.
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ALL augmentation
Anterolateral Ligament reconstruction added to ACL surgery for high-risk knees — young, pivot-sport athlete, hyperlaxity.
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MPFL reconstruction
Medial Patellofemoral Ligament reconstruction for recurrent kneecap dislocation. See /treatments/kneecap-stabilisation.
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PCL, MCL and PLC surgery
Most isolated PCL and MCL tears are managed non-operatively; multi-ligament and posterolateral corner injuries need reconstruction.
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Microfracture / marrow stimulation
Small holes made in the bone under a cartilage defect to draw in marrow cells — best for small (<2 cm²) lesions.
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MACI cartilage repair
Matrix-Associated Autologous Chondrocyte Implantation (NICE TA477). A 2-stage biopsy-then-implantation procedure for medium-large defects.
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OATS / osteochondral allograft
Plug transfer of cartilage-and-bone from a low-load area, or from a donor, into the damaged surface.
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High tibial osteotomy
HTO — the tibia is cut and realigned to offload the medial compartment in the bow-legged knee. See /treatments/high-tibial-osteotomy.
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Distal femoral osteotomy
DFO — the femur is cut and realigned to offload the lateral compartment in the knock-kneed knee.
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Tibial tubercle transfer
Medialisation or anteromedialisation (Fulkerson) for patellar instability or patellofemoral offloading.
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Patellofemoral joint replacement
Resurfacing the kneecap-and-trochlear-groove joint only, in isolated patellofemoral OA. See /treatments/kneecap-joint-replacement-surgery.
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Unicompartmental knee replacement
UKA — replaces only the worn compartment, preserving bone and ligaments. A bone-preserving alternative to full replacement.
Also worth knowing: genicular artery embolisation as a delayed, non-surgical option; hyaluronic acid and PRP injections in selected cases; and specialist knee physiotherapy as the constant that makes every preservation procedure work.
Our vetted UK network
A small panel of knee surgeons, we picked them.
Consultant knee-preservation surgeons across London, Manchester, Birmingham, Bristol, Leeds and Edinburgh. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every knee surgeon in our network.
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Consultant knee surgeons with a fellowship in knee preservation and sports injury
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BASK — British Association for Surgery of the Knee — membership as a minimum standard
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Regular meniscal repair, ACL and cartilage-repair volume, not occasional practice
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Access to specialist knee physiotherapy, MACI-approved centre and long-leg alignment imaging
Selection, safety and recovery
What to expect — honestly.
Knee preservation surgery is safe when the patient is well-selected. The realistic promise is a knee that gives you another decade or two — not a lifetime — before a replacement is considered.
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Selection matters more than technique
Age (usually under 50–55 for major osteotomy), preserved joint space, correctable pathology, motivated and compliant — the honest patient selection is what makes preservation work.
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Rehabilitation is not optional
A specialist knee physio programme is as important as the surgery itself. Skimp on rehab and the surgery underperforms — every time. See /treatments/knee-physiotherapy.
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This delays replacement, it does not replace it
Realistic expectations: preservation surgery buys 10–20 years, not a lifetime. Most patients still convert to a partial or full replacement eventually.
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Infection, DVT and PE are the surgical risks
As with any joint surgery. Chemical thromboprophylaxis, early mobilisation and antibiotic prophylaxis are standard.
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Stiffness and pain do not always resolve
A minority of patients have persistent pain, stiffness or an incomplete symptom resolution — worth discussing before you commit.
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Osteotomy has its own hazards
Non-union, delayed union, hardware pain and occasional need for hardware removal 12–18 months down the line. Uncommon, but real.
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Cartilage repair can fail
Especially in older patients, larger defects, or where the underlying alignment has not been corrected. Alignment surgery often goes with cartilage repair for that reason.
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Eventual arthroplasty is not a failure
A preservation procedure that got you 15 pain-free years before a knee replacement has done its job — that is the correct way to judge it.
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Red flags after surgery
Fever, spreading redness, calf swelling or pain, chest pain or breathlessness are not normal — call the clinic or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever preservation procedure was done, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and procedure performed
Why the operation was done — meniscal tear, ACL rupture, cartilage defect, malalignment — and exactly which procedure was carried out.
- 02 Technique
Graft, fixation and technique
Which graft (hamstring, BPTB, quadriceps, allograft), which fixation (endobutton, screw, staple), and any augmentation such as InternalBrace or ALL.
- 03 Findings
Intra-operative findings
What was actually seen — cartilage grade, meniscal repairability, ligament status — and any incidental findings that change your rehab.
- 04 Impression
Rehab protocol and return-to-sport timeline
Read this first: weight-bearing status, brace instructions, physio referral, and expected return-to-sport milestone.
Recognised by major UK insurers
Cover for knee preservation surgery varies by insurer, by procedure and by graft type. MACI and meniscal allograft transplantation often need pre-authorisation. We confirm cover before booking.
Frequently asked
Everything we get asked about knee preservation.
Quick answers on candidacy, cost, recovery, and how the preservation spectrum fits together.
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What is knee preservation surgery?
An umbrella term for joint-preserving operations in a knee that is worn or injured but not yet ready for replacement. It includes meniscal repair, ACL and other ligament reconstruction, cartilage repair (MACI, OATS, microfracture), realignment osteotomy (HTO, DFO), and bone-sparing partial or patellofemoral replacements. The aim is to keep the joint you were born with for another 10–20 years.
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Who is a candidate for knee preservation rather than knee replacement?
Typically younger and active patients — under 50 or 55 for major osteotomy — with correctable pathology (a repairable meniscus, a discrete cartilage lesion, malalignment, single-compartment wear), preserved joint space on the other compartments, motivation to complete rehab, and realistic expectations. A knee-preservation surgeon assesses all of that before recommending.
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What is the difference between meniscal repair and meniscectomy?
A repair stitches the torn meniscus back together — usually all-inside with devices like FasT-Fix or OMNI — and preserves meniscal function long term. A meniscectomy removes the torn portion. Repair is preferred whenever possible; NICE NG226 explicitly does not recommend arthroscopic meniscectomy for degenerative OA-related tears.
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What is MACI and who is it for?
MACI — Matrix-Associated Autologous Chondrocyte Implantation — is a NICE-approved (TA477) two-stage cartilage repair. Stage one takes a cartilage biopsy at arthroscopy. The cells are cultured on a scaffold over six weeks. Stage two implants the scaffold into the defect. It suits younger patients with a medium-to-large discrete cartilage lesion and an otherwise healthy joint.
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What is a high tibial osteotomy and when is it recommended?
HTO is a realignment operation for the bow-legged (varus) knee with isolated medial-compartment wear. The tibia is cut and opened up, shifting load away from the worn compartment onto the healthy one. It preserves the joint and typically buys 10–15 years before any consideration of replacement. See /treatments/high-tibial-osteotomy.
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What is the ALL and when is it added to ACL reconstruction?
The Anterolateral Ligament is a small structure on the outer side of the knee. Augmenting an ACL reconstruction with an ALL reconstruction reduces re-rupture rates in high-risk patients — young athletes, pivot sports (football, rugby, netball, skiing), generalised hyperlaxity, or after a previous ACL failure. It is not needed for every ACL reconstruction.
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How much does knee preservation surgery cost privately in the UK?
Roughly £4,000–£8,000 for arthroscopy with meniscal work, £8,000–£14,000 for ACL reconstruction, £10,000–£14,000 for HTO, £16,000–£28,000 for MACI (two stages), and £13,000–£20,000 for a unicompartmental replacement. Consultation is £250–£450. NHS-funded via specialist knee-preservation services where indicated.
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How long is the recovery?
It depends on the procedure. A simple arthroscopy is 2–6 weeks back to normal life. Meniscal repair needs protected weight-bearing for 4–6 weeks. ACL reconstruction is 9–12 months to full pivoting sport. HTO, DFO and MACI are 9–12 months to full return. Specialist knee physiotherapy is essential throughout — see /treatments/knee-physiotherapy.
Related treatments
Looking for something else?
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Knee arthroscopy
Keyhole knee surgery — meniscal work, chondroplasty, loose body.
Learn more -
High tibial osteotomy
Realignment for the varus knee with medial-compartment wear.
Learn more -
Patellofemoral joint replacement
Resurfacing for isolated kneecap-joint arthritis.
Learn more -
Kneecap stabilisation
MPFL reconstruction for recurrent patellar dislocation.
Learn more -
Knee replacement
When preservation is not the right answer any more.
Learn more -
All tests & procedures
Every test and procedure we arrange.
Learn more