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The ACL SNNAP – Anterior Cruciate Ligament Surgery Necessity in Non Acute Patients trial recently obtained green light from OCTRU; and has already set up 3 sites that soon will start recruiting (University Hospitals Coventry and Warwickshire NHS Trust, Sherwood Forest Hospitals NHS Foundation Trust and Yeovil District Hospital NHS Foundation Trust). This study will compare the clinical and cost effectiveness of two management strategies for non-acute Anterior Cruciate Ligament (ACL) injury: rehabilitation versus surgical reconstruction. 


An ACL rupture is a common knee injury, which often occurs during high-intensity sports; this causes the knee joint to become very unstable and restrict movement. Currently there are two main NHS treament options for this problem, non-surgical treatment (physiotherapy) or surgery to replace the torn ligament (ACL reconstruction). Currently the clinical management varies from surgeon to surgeon and hospital to hospital. Some surgeons feel that patients should always undergo surgery as soon as possible to stabilise the joint, preventing buckling and stop any further damage (at least 13,941 of these operations were performed in the UK last year, costing an average of £60 million per year). Conversely some surgeons feel that a period of rehabilitation (exercises) should always be prescribed as it may be possible to avoid an operation altogether.

Both interventions are routine NHS treatments; and this study aims to determine in patients with non-acute (greater than 4 months since injury) ACL deficiency whether a strategy of non-surgical management (with option for later ACL reconstruction, only if required) is more clinically and cost effective than a strategy of surgical management:

-        This is a pragmatic, multi-centre randomised controlled trial with two parallel groups and 1:1 allocation ratio

-        It is planned to recruit at 20 Sites in the UK and recruit 320 patients

-        Patients over 18 with a non-acute ACL deficiency can be potentially eligible for this trial, if they meet the protocol criteria

-        Patients will report their condition at Baseline upon recruitment and at 6, 12 and 18 months after being allocated to a management strategy, through an electronic questionnaire (that the trial management team will send through email and can be completed anywhere using a computer/tablet). 


For more information please visit the ACL SNNAP website:



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