Rehabilitation versus Surgical Reconstruction for Non-Acute Anterior Cruciate Ligament Injury (ACL SNNAP): A Pragmatic Randomised Controlled Trial

The ACL SNNAP trial was a pragmatic, multicentre, randomised controlled trial conducted across 29 UK NHS orthopaedic units, comparing surgical ACL reconstruction against structured rehabilitation for patients with non-acute ACL injury and persistent instability symptoms. Enrolling patients with symptomatic knee instability, the study found that surgical reconstruction was clinically superior and more cost-effective compared with a rehabilitation-first strategy. These findings provide important evidence to guide decision-making for patients whose ACL injury has moved beyond the acute phase without early surgery.