Introduction
You might have been told by the specialist that you have a cartilage injury in your joint, most often in the knee or ankle. In certain cases, the affected cartilage lies at the kneecap (patella), making activities like climbing stairs or running increasingly difficult. Such injuries are usually diagnosed by an orthopaedic surgeon and confirmed with MRI scans, often followed by a recommendation for cartilage repair surgery. At this point, it’s normal to pause and reflect. Should you really go through with surgery? What are the chances of a good recovery? Are you in safe and capable hands? These questions form part of the decision-making process every patient faces before agreeing to a procedure.
In Singapore, the most common cartilage repair surgery performed today is an augmented bone marrow stimulation technique combined with a single-step scaffold insertion (Figure 1 and 2). While there are various ways to perform this surgery, one particular technique published by my team has been widely adopted and featured in several scientific papers1,2. I, Dr Francis Wong, actively teach these methods in local hospitals and workshops as a Visiting Consultant, and also on the international stage through the International Cartilage Regeneration and Joint Preservation Society (ICRS) masterclasses, which bring surgeons from around the world together to learn and refine these skills3. With this range of approaches available, the next important consideration is whether these techniques are aligned with current international guidelines.
Is this Technique Aligned with International Guidelines?
This important question has already been addressed by the National Institute for Health and Care Excellence (NICE) in the UK, which has published guidelines supporting the use of single-step scaffold insertion for repairing symptomatic chondral knee defects4. NICE is among the most reputable guideline bodies in the world, and its recommendations are often adopted internationally because of the robust methodology used in their development. In summary, this confirms that the technique is considered a feasible treatment option for knee cartilage tears or defects, with the most recent update released on 5 August 2025. At present, there are no equivalent guidelines for ankle cartilage repair, although similar recommendations are expected in the near future and are likely to reflect those already issued for the knee.
Recommendations from NICE
Following its endorsement of single-step scaffold insertion for symptomatic chondral knee defects, NICE sets out four recommendations to help ensure the procedure is delivered safely and with the best possible outcomes. This helps patients evaluate which orthopaedic surgeon or clinic is appropriately set up for this surgery.
Use of Single-step Scaffold Insertion
Single-step scaffold insertion can be used as an option for repairing symptomatic chondral knee defects when standard arrangements for clinical governance, consent, and audit are in place, which confirms augmented bone marrow stimulation plus single-step scaffold insertion is a feasible option delivered in the Ministry of Health’s (MOH) registered day surgery centres, medical centres, or hospitals where surgeons and outcomes are audited, criteria that accredited venues in Singapore satisfy through governance, consent processes, and audit trails.
Participation in Suitable Registries
Healthcare professionals should enter details of every single-step scaffold insertion into a suitable registry such as the ICRS, which supports regular auditing against international standards. As cartilage repair techniques are ever evolving, each step in the surgery can be updated to improve patient outcomes, ensuring that it remains on par with global benchmarks.
Multidisciplinary Patient Selection
This is yet another important point, where cartilage injuries are best managed by a multidisciplinary team who knows what they are doing. Not all cartilage injuries require surgery! Although there are many orthopaedic surgeons, physiotherapists, and radiologists out there, not all are trained specifically in cartilage repair surgery, diagnosis, surgery, and rehabilitation. Most importantly, a multidisciplinary team can help prevent unnecessary surgery as there are cases that would fare better with non-surgical methods, such as physiotherapy or intra-articular injections.
Performed by Orthopaedic Surgeons with Specific Training
This last point is perhaps the most important for patients considering cartilage repair surgery. The key is that cartilage repair is very different from larger operations such as a knee replacement or fracture fixation. It is a precision‑dependent surgical procedure in which every millimetre matters, and scaffold placement must be exact or the surgery will not succeed.
Oxford Sports and Cartilage Centre’s Expertise and Training
Building on these recommendations, patients deserve assurance that international standards guide care from diagnosis through rehabilitation. First, in terms of academic and formal training, I am the first orthopaedic surgeon from South East Asia to complete the ICRS international cartilage fellowship, followed by mentorship with experts in North America and Europe, and with regards to the science of cartilage regeneration, a PhD at NUS. Next, in professional leadership and teaching, I serve as Deputy Chairman of the ICRS NexGen Committee and teach regularly as international faculty at ICRS’ world congresses and workshops, which reflects ongoing peer review and leadership in technique development.
Finally, in daily practice, these credentials translate into routine application of validated methods: each surgery is entered into the registry, advanced cartilage mapping MRI to ascertain the severity of the damage cartilage5,6, structured prehabilitation and rehabilitation are provided by trained physiotherapists, and surgeon-led decisions integrate non-surgical and surgical repair so each case benefits from precise technique, clear indications, and continuous refinement toward safer surgery, better outcomes, and timely return to activity.
Speak to Oxford Cartilage & Sports Centre (Oxford Orthopaedics)
If there are suspicions of a cartilage injury or it has already been diagnosed, book a consultation at Oxford Cartilage & Sports Centre by Oxford Orthopaedics to align care with current international recommendations and audited practice. The centre follows NICE guidance for single-step scaffold insertion, contributes to the ICRS registry, and delivers care through a multidisciplinary team, so decisions and technique are benchmarked to global standards. To speak with Dr Francis Wong, please contact the clinic to book an appointment.
References
- Ow ZGW, Ting KJE, Wong KL. Single-Stage Arthroscopic Cartilage Repair With Chondrectomy and Implantation of a Templated Membrane Collagen Scaffold With Bone Marrow Aspirate Concentrate Augmentation (AMIC Plus). Arthrosc Tech. 2023 Oct 30;12(11):e2085-e2091. doi: 10.1016/j.eats.2023.07.030. PMID: 38094947; PMCID: PMC10714417.
- Zhang EJX, Ow ZGW, Lie EV, Dhanaraj ID, Wong KL. Arthroscopic Cartilage Repair of the Patella With Minced Cartilage and Collagen Membrane Scaffold With Bone Marrow Aspirate Concentrate. Arthrosc Tech. 2024 Nov 13;14(4):103308. doi: 10.1016/j.eats.2024.103308. PMID: 40453020; PMCID: PMC12126052.
- https://www.linkedin.com/posts/international-cartilage-repair-society-icrs_icrs2025-icrssurgicalskills-activity-7278379123398381568-Z3fN/
- https://www.nice.org.uk/guidance/ipg793. NICE guidelines for single step scaffold insertion for repairing symptomatic chondral knee defects.
- Ow ZGW, Wang D, Zhang EJX, Hamid Razak, Wong SBS, Xiu JMH, Wong KL. Assessing acellular scaffold viability with T2-weighted relaxation time value imaging: imaging variables and early clinical associations at 6 months following patellofemoral cartilage repair. Journal of Cartilage & Joint Preservation, Volume 4, Issue 2,2024,100185,ISSN 2667-2545, https://doi.org/10.1016/j.jcjp.2024.100185.
- Ow ZGW, Tan MWP, Gengatharan D, Zhang EJX, Cher EWL, Debieux P, Wong KL. Biologic Augmented Scaffold-based cartilage repair: Addressing Complications and Enhancing Outcomes. J Clin Orthop Trauma. 2025 Jan 6;62:102905. doi: 10.1016/j.jcot.2025.102905. PMID: 39886535; PMCID: PMC11774828.
