- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02980367
ACL SNNAP Trial: ACL Surgery Necessity in Non Acute Patients (ACL SNNAP)
Comparison of the Clinical and Cost Effectiveness of Two Management Strategies for Non-acute Anterior Cruciate Ligament (ACL) Injury: Rehabilitation Versus Surgical Reconstruction.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The ACL SNNAP study is a pragmatic multi-centre randomised controlled trial with two-arm parallel groups and 1:1 allocation ratio to compare non-surgical management (Rehabilitation) and surgical management (Reconstruction) options for patients with a symptomatic non-acute ACL deficient knee.
The objective is to determine, in patients with non-acute Anterior Cruciate Ligament Deficiency (ACLD), whether non-surgical treatment (with the option for later ACL reconstruction if required) is more effective than surgical ACL reconstruction (as measured by the Knee Injury and Osteoarthritis Outcome Score [KOOS4] at 18 months from randomisation).
Target sample size is 320 patients recruited from approx. 30 NHS orthopaedic units.
An internal pilot will be conducted with clear progression criteria regarding recruitment.
Both interventions are routine NHS treatments. Intervention content is based on a minimal set of pre-established criteria in order to ensure the integrity of the comparison while allowing for varying in practice in delivering the interventions between both surgeons and physiotherapists. This largely pragmatic approach will allow clinical management to reflect current practice and resource use within the NHS thus aiding generalisation.
Other than the allocated intervention, both groups will be followed-up in the same way to exclude bias. Follow up for study purposes will be by patient self-reported questionnaire completed using an electronic data capture collection system (a postal option will also be available). The questionnaire will include the outcomes indicated in section 4 and will be completed by participants at baseline, 6, 12 and 18 months. Non-response will be minimised through use of multiple reminders such as web based, phone and text.
Neither participants nor health care practitioners (surgeons and physiotherapists) can be blinded to receipt of the intervention.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: David Beard
- Phone Number: 01865 737210
- Email: ACL_SNNAP@ndorms.ox.ac.uk
Study Contact Backup
- Name: Loretta Davies
- Phone Number: 01865737210
- Email: loretta.davies@ndorms.ox.ac.uk
Study Locations
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Bangor, United Kingdom
- Recruiting
- Betsi Cadwaladr University Health Board
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Basildon, United Kingdom
- Recruiting
- Basildon and Thurrock University Hospitals NHS Foundation Trust
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Contact:
- Sean Symons
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Bristol, United Kingdom
- Recruiting
- North Bristol NHS Trust
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Contact:
- James Murray
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Cheltenham, United Kingdom
- Recruiting
- Gloucestershire Hospitals NHS Foundation Trust
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Chester, United Kingdom
- Recruiting
- Countess Of Chester Hospital NHS Foundation Trust
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Contact:
- Raghuram Thonse
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Coventry, United Kingdom
- Recruiting
- University Hospitals Coventry and Warwickshire NHS Trust
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Frimley, United Kingdom
- Recruiting
- Frimley Health NHS Foundation Trust
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Guildford, United Kingdom
- Recruiting
- Royal Surrey County Hospitals NHS Foundation Trust
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Contact:
- Oliver Templeton-Ward
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Hull, United Kingdom
- Recruiting
- Hull and East Yorkshire Hospitals NHS Trust
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Contact:
- Reza Mayahi
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Leeds, United Kingdom
- Recruiting
- Leeds Teaching Hospitals NHS Trust
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Leicester, United Kingdom
- Recruiting
- University Hospitals of Leicester
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London, United Kingdom
- Recruiting
- University College London Hospitals NHS Foundation Trust
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London, United Kingdom
- Recruiting
- Kings College Hospital NHS Foundation Trust
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Contact:
- Barry Andrews
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Manchester, United Kingdom
- Recruiting
- Manchester University NHS Foundation Trust
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Contact:
- Pankaj Sharma
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Oxford, United Kingdom
- Recruiting
- Oxford University Hospitals Nhs Foundation Trust
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Peterborough, United Kingdom
- Recruiting
- North West Anglia NHS Foundation Trust
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Portsmouth, United Kingdom
- Recruiting
- Portsmouth Hospitals NHS Trust
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Contact:
- Jeremy Rushbrook
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Reading, United Kingdom
- Recruiting
- Royal Berkshire NHS foundation trust
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Salisbury, United Kingdom
- Recruiting
- Salisbury NHS Foundation Trust
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Contact:
- Leonidas Vachtsevanos
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Sheffield, United Kingdom
- Recruiting
- Sheffield Teaching Hospitals NHS Foundation Trust
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Slough, United Kingdom
- Recruiting
- Frimley Health NHS Foundation Trust
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Stockport, United Kingdom
- Recruiting
- Stockport NHS Foundation Trust
-
Contact:
- David Johnson
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Sutton In Ashfield, United Kingdom
- Recruiting
- Sherwood Forest Hospitals NHS Foundation Trust
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Swansea, United Kingdom
- Recruiting
- Abertawe Bro Morannwg University Health Board
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Swindon, United Kingdom
- Recruiting
- Great Western Hospitals NHS Foundation Trust
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Taunton, United Kingdom
- Recruiting
- Taunton and Somerset NHS Foundation Trust
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Contact:
- Andrew Kelly
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Truro, United Kingdom
- Recruiting
- Royal Cornwall Hospitals NHS Trust
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Contact:
- Robin Kincaid
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Wakefield, United Kingdom
- Recruiting
- The Mid Yorkshire Hospitals NHS Trust
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Contact:
- Jon Smith
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Warrington, United Kingdom
- Recruiting
- Warrington and Halton Hospitals NHS Foundation Trust
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Wigan, United Kingdom
- Recruiting
- Wrightington, Wigan and Leigh NHS Foundation Trust
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Contact:
- Ben Coupe
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Wrexham, United Kingdom
- Recruiting
- Betsi Cadwaladr University Health Board
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Contact:
- Yeogesh Joshi
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Yeovil, United Kingdom
- Recruiting
- Yeovil District Hospital NHS Foundation Trust
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Participant is willing and able to give informed consent for participation in the study.
- Male or Female, aged 18 years or above.
- Symptomatic ACL deficiency of the native ligament1 (instability-episodes of frank giving way or feeling unstable) with ACL deficiency (either partial or complete tear) confirmed using clinical assessment and MRI scan.
Exclusion Criteria:
- Acute phase of primary ACL injury i.e. not recovered from any acute symptoms relating to their initial ACL injury.
- Previous knee surgery (other than diagnostic arthroscopy or partial meniscectomy) to index knee concomitant severe injury to contra-lateral knee.
- Meniscal pathology with characteristics that indicate immediate surgery i.e. locked knee, large bucket handle or complex cartilage tear producing mechanical symptoms.
- Knee joint status of grade 3 or 4 on the Kellgren and Lawrence scale,
- Grade 3 MCL/LCL injury, associated PCL/PLC injury
- Inflammatory arthropathy.
- Pregnancy.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: ACL Rehabilitation Group
Non-surgical management [Rehabilitation] with option for later Anterior Cruciate Ligament (ACL) reconstruction, only if required.
|
Routine ACL rehabilitation protocols used at the participating site will be followed.
As part of the site selection process, documentary evidence of the use of or willingness to adopt a rehabilitation protocol that reflects the guidelines of the mandatory aims/goals set for the study rehabilitation intervention will be required.
Other Names:
|
Active Comparator: ACL Reconstruction Group
Surgical Management - Anterior Cruciate Ligament (ACL) reconstruction surgery
|
All surgical reconstructions will be patella tendon or hamstrings tendon depending on the surgeon's preference.
All other care will be routine, including immediate post-operative care.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Knee Injury and Osteoarthritis Outcome Score (KOOS4)
Time Frame: 18 months post randomisation
|
The score is derived from 4 of 5 subscales; pain, symptoms, difficulty in sports and recreational activities, knee related quality of life.
|
18 months post randomisation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Knee Injury and Osteoarthritis Outcome Score (KOOS)
Time Frame: At baseline and at 6, 12 and 18 months post randomisation
|
All 5 subscales of the KOOS will be included (the fifth scale being activities of daily living). Anterior Cruciate Ligament Quality of Life Score (ACL-QOL) |
At baseline and at 6, 12 and 18 months post randomisation
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Modified Tegner scale
Time Frame: At baseline and at 6, 12 and 18 months post randomisation
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Activity level will be assessed using the Modified Tegner scale, graded from 1 (low activity levels) to 10 (professional level).
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At baseline and at 6, 12 and 18 months post randomisation
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Intervention related complications
Time Frame: At 6, 12 and 18 months post randomisation
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Any complications associated with undergoing ACL deficiency treatment will be recorded.
This includes; for surgery group; re-admission, delayed hospital discharge, infection, unexpected poor range of movement (stiffness), excess bleeding, continued swelling, episodes of giving way, continued feeling of instability.
For non-surgical group; continued swelling, episodes of giving way.
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At 6, 12 and 18 months post randomisation
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EuroQol EQ-5D-5L
Time Frame: At baseline and at 6, 12 and 18 months post randomisation
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Generic quality of life (self-reported outcome measure covering 5 health domains and used to facilitate the calculation of Quality Adjusted Life Years in health economic evaluations).
|
At baseline and at 6, 12 and 18 months post randomisation
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Resource-usage data
Time Frame: 18 months post randomisation
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Detailed resource use data on initial treatments received (surgical reconstruction or rehabilitation) and on subsequent healthcare contacts including re-operations (surgery arm), subsequent surgical reconstructions (rehabilitation arm), surgery-related complications, further rehabilitation, and primary care and other secondary care contacts out to 18 months post-randomisation.
In addition, data will be collected on ability to work (e.g.
sickness absences/return to work number of days off work and subjective working ability).
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18 months post randomisation
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Anterior Cruciate Ligament Quality of Life score (ACL-QOL)
Time Frame: At baseline and at 6, 12 and 18 months post randomisation
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Expectations of return to activity and confidence in relation to the knee.
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At baseline and at 6, 12 and 18 months post randomisation
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Patient satisfaction
Time Frame: At baseline and at 6, 12 and 18 months post randomisation
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Simple Likert scale
|
At baseline and at 6, 12 and 18 months post randomisation
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Collaborators and Investigators
Sponsor
Publications and helpful links
General Publications
- Beard DJ, Davies L, Cook JA, Stokes J, Leal J, Fletcher H, Abram S, Chegwin K, Greshon A, Jackson W, Bottomley N, Dodd M, Bourke H, Shirkey BA, Paez A, Lamb SE, Barker K, Phillips M, Brown M, Lythe V, Mirza B, Carr A, Monk P, Morgado Areia C, O'Leary S, Haddad F, Wilson C, Price A; ACL SNNAP Study Group. Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial. Lancet. 2022 Aug 20;400(10352):605-615. doi: 10.1016/S0140-6736(22)01424-6.
- Davies L, Cook J, Leal J, Areia CM, Shirkey B, Jackson W, Campbell H, Fletcher H, Carr A, Barker K, Lamb SE, Monk P, O'Leary S, Haddad F, Wilson C, Price A, Beard D. Comparison of the clinical and cost effectiveness of two management strategies (rehabilitation versus surgical reconstruction) for non-acute anterior cruciate ligament (ACL) injury: study protocol for the ACL SNNAP randomised controlled trial. Trials. 2020 May 14;21(1):405. doi: 10.1186/s13063-020-04298-y.
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
- ACL
- Anterior Cruciate Ligament
- ACL reconstruction
- Anterior Cruciate Ligament deficiency
- ACL deficiency
- ACLD
- Anterior Cruciate Ligament reconstruction
- Anterior Cruciate Ligament physiotherapy
- Anterior Cruciate Ligament rehabilitation
- ACL physiotherapy
- ACL rehabilitation
- Anterior Cruciate Ligament management
- ACL management
Additional Relevant MeSH Terms
Other Study ID Numbers
- 12096
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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