Denied ACL Surgery - Next Steps?

For context, I am 32M, 110kg (heavy I know) and overweight but larger amount of muscle mass to fat ratio (around 25% BF) than normal. I am also in the UK and under NHS healthcare, not private.

In July 2023, I sustained a Grade III ACL tear and an incomplete tear on my medial meniscus during football (soccer). My first MRI was in April 2024 and then I was put into ‘pre-hab’ on a twelve week programme from October to December 2024. I have just had my assessment for surgery and was denied on the basis that my knee is now stable and I no longer ‘buckle’ as I first did in the first few months of my injury. This was confirmed by the physio during prehab. I am able to do all leg exercises and stair jumps.

I fought back explaining how I’m aware that the ACL can continue to cause degradation in the knee and with the meniscus tear, it could exacerbate this. I also raised the likelihood of early-onset osteoarthritis and the Doctor just palmed it off with “well you’re going to get that now anyways, fix or no fix”. I also pushed for the fact that I don’t fancy a total knee replacement in 10-20 years time and would rather have the ACL fixed now, but again to no avail. I was told to try private.

Lifestyle wise, I am very active in the gym now. 4-5 times a week and regularly hike (medium effort). I no longer buckle and haven’t had a buckling episode since 2023. I have naturally large hamstrings, quads and calves so my legs feel solid but I do have a lot of pain in the front and back of the knee, with some bouts of swelling. I no longer play football or get involved in any HIIT, mainly weightlifting (incl. squats), cycling, hiking and swimming.

The NHS won’t budge, I’ve been discharged completely without my consent and fighting them won’t achieve anything. I am wondering if it would be worth having this fixed or if my lifestyle would mean that I might just get on fine. The average cost to have the reconstruction done privately is around £8,000 - £10,000 ($12,000). This would be fully out of pocket and would not include post-op physio.

My biggest concern is my meniscus tearing completely, causing my knees to lock in and have me on a cane. A little over-exaggeration but I’d rather know what my chances are early. I’d really appreciate any advice anyone can give, especially those who did not have surgery and how it has panned out for you.