Lay summary
Anterior cruciate ligament (ACL) rupture is a serious knee injury that affects thousands of New Zealanders annually with long-term impacts on pain, function, work, and sports. ACL rupture is managed with rehabilitation or surgery. Most people should complete rehabilitation before considering surgery, but most New Zealanders receive surgery as first-line care. Two-years following ACL surgery, one-third of people have ongoing unacceptable symptoms and almost half have osteoarthritis. This is worse for Māori and people from Pacific communities. New evidence suggests ACL ruptures can heal without surgery and the novel Cross-Bracing Protocol may increase healing. The Enhancing Non-operative Care Of Rupture: Equity and Effectiveness (ENCORE) trial will compare the Cross-Bracing Protocol to rehabilitation alone, measuring pain, symptoms, sports, work, quality of life, costs, ligament healing, and need for surgery. We will recruit equal numbers of Māori, Pacific, and non-Māori/non-Pacific participants so that results apply to communities currently experiencing the worst outcomes.