NIHR supportRecorded as supported by this research centre
PeriodFeb 2025 — Dec 2029
In plain English
AI plain-English summary
Every year, thousands of people who tear their anterior cruciate ligament face a choice between two surgical paths—and no one knows which is better. The problem is that the standard operation, reconstruction, works well but requires drilling into bone and harvesting tissue from elsewhere in the body, such as the hamstrings. An alternative—repair—reattaches the torn ligament itself, avoiding that damage. Repair could mean faster recovery, better long-term knee stability, and a lower chance of developing osteoarthritis later in life. But there is no robust evidence to prove it. This trial will settle the question. Adults with ACL injuries who are suitable for either operation will be randomly assigned to reconstruction or repair, and neither they nor their assessors will know which they received. The researchers will compare knee function using a standard questionnaire, along with pain scores and longer-term follow-up. If repair proves superior, it could change surgical practice across the NHS—offering patients a less invasive option that preserves their own tissue and may prevent the joint damage that leads to osteoarthritis decades later.
View original technical description
The Anterior Cruciate Ligament (ACL) is an important band of tissue that supports the knee. It is a strong structure in the centre of the knee which attaches the femur (thigh bone) to the tibia (shin bone). Often injured during sport, injury to the ACL can lead to the knee becoming unstable and giving way. An unstable knee can cause damage to other parts of the knee like the cartilage or meniscus (shock absorbers), which can lead to osteoarthritis (OA) developing in later life. The most common surgical treatment option is reconstruction, which uses tissue from other parts of the body, such as the hamstrings, to act as a replacement. This is a successful operation but involves damage to bones from drilling holes and removal of tissue from elsewhere in the body. An alternative approach is to reattach the original ligament back from where it has torn in a “repair” rather than reconstruction. By preserving the ligament, avoiding tissue harvest and bone drilling, ACL repair could provide faster recovery, better medium to long term stability, and might reduce likelihood of future OA. We aim to conduct a comparative study to find out which is the best technique, reconstructing the ligament or repairing it, as measured by a questionnaire about knee function at 24 months. People who have injured their ACL, who may be suitable for either operation, will be invited to join the study. Participants will be randomly allocated to one of the two types of ACL surgery. They won't be told which surgery they have had. Participants will be asked to complete a pain score at 3 and 6 weeks after surgery. Then they will be asked to complete questionnaires relating to their knee at 6-, 12- and 24-months post-surgery.
Musculoskeletal, Surgery, Inflammation and Recovery
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