Research and Evidence-Based Knee Surgery

Evidence-based medicine is the foundation of modern healthcare. Research-active hospitals have been associated with improved patient outcomes, highlighting the importance of clinical research in advancing treatments and improving care for both current and future patients.

Mr Nick Smith is a Consultant Specialist Knee Surgeon at University Hospitals Coventry and Warwickshire (UHCW), with an established academic and clinical research portfolio focused on soft-tissue knee surgery, sports injuries and knee preservation.

His research training began at the University of Nottingham, where he obtained a Bachelor of Medical Sciences (BMedSci). He subsequently completed a Master’s degree in Health Sciences (Trauma and Orthopaedics), awarded with distinction by the University of Warwick. He was then awarded research funding to undertake a PhD at the University of Warwick investigating the clinical outcomes of meniscal allograft transplantation. This work received multiple awards, including the prestigious Robert Jones Medal, and contributed to an internationally cited body of research.

Nick has continued to develop an extensive research programme spanning meniscal transplantation, ACL reconstruction, ligament augmentation, meniscal repair, tibial slope and knee preservation surgery. He has played a leading role in major multicentre clinical trials, including NIHR-funded randomised controlled trials, and has contributed to securing approximately £4 million in research funding.

His research combines the evaluation of emerging surgical technologies with rigorous clinical assessment of established treatments, aiming to improve surgical decision-making, patient outcomes and long-term knee health.

Research Publications and Academic Profiles

Nick’s peer-reviewed publications, citation metrics and wider academic contributions can be explored through his research profiles:

The sections below highlight a selection of his current and recent research projects, including clinical trials, collaborative studies and innovations in soft-tissue knee surgery.

  • ACL recon LET vs no LET

    STABILITY Study (Getgood et al., 2020) Lateral Extra-articular Tenodesis (LET) in ACL Reconstruction 🔗 https://pubmed.ncbi.nlm.nih.gov/31940222/ Getgood AMJ, et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial. Am J Sports Med. 2020 Feb;48(2):285-297. doi: 10.1177/0363546519896333. Epub 2020 Jan 15. PMID: 31940222. Key

  • ACL Reconstruction and the “Delta Angle”

    https://pubmed.ncbi.nlm.nih.gov/40690738/ Evidence base Ayuob A, Raj S, Jessup J, Searle HKC, Ahmed I, Thompson P, Shah F, Metcalfe A, Smith N. Introducing “Delta Angle” of Posterior Tibial Slope and Its Impact on ACL Reconstruction Failures: A Regression Analysis of 1174 Patients. Am J Sports Med. 2025 Aug;53(10):2387-2396. doi: 10.1177/03635465251355213. Epub 2025 Jul 21. PMID: 40690738.

  • ACL reconstruction with quadriceps or patellar tendon grafts, and tenodesis (STABILITY 2 trial)

    One of the most important research projects in ACL reconstruction came from the STABILITY 1 trial, which was a randomised trial comparing ACL reconstruction with or without lateral extra-articular tenodesis (an extra part to the operation, in which a section of iliotibial band on the outside of the knee is connected in to the thigh

  • Meniscal Root Tears

    https://pubmed.ncbi.nlm.nih.gov/35755791/ Diagnosis, Consequences and Treatment Evidence Base Banovetz MT, Roethke LC, Rodriguez AN, LaPrade RF. Meniscal Root Tears: A Decade of Research on their Relevant Anatomy, Biomechanics, Diagnosis, and Treatment. Arch Bone Jt Surg. 2022 May;10(5):366-380. doi: 10.22038/ABJS.2021.60054.2958. PMID: 35755791; PMCID: PMC9194705. Key Points Meniscal root tears are serious injuries that can behave like complete

  • Recovery After ACL Injury

    https://pmc.ncbi.nlm.nih.gov/articles/PMC12582240/ Evidence base Ridha A, Raj S, Searle H, Ahmed I, Smith N, Metcalfe A, Khatri C. The recovery trajectory of anterior cruciate ligament ruptures in randomised controlled trials: A systematic review and meta-analysis of operative and nonoperative treatments. Knee Surg Sports Traumatol Arthrosc. 2025. https://doi.org/10.1002/ksa.12626 This study was conducted by our team to better

  • Return to Sport After Knee Replacement

    https://pmc.ncbi.nlm.nih.gov/articles/PMC5765989/ Evidence base Dagneaux L, Bourlez J, Degeorge B, Canovas F. Return to sport after total or unicompartmental knee arthroplasty: an informative guide. EFORT Open Rev. 2017. This review summarises the current evidence on returning to sport after knee replacement, including both total knee replacement (TKR) and partial knee replacement (UKR). Key points Most patients

  • TKR vs UKR

    TOPKAT Trial – 5-Year Outcomes (Beard et al., 2019) Total vs Partial Knee Replacement for Medial Knee Arthritis 🔗 Beard DJ, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet. 2019 Aug 31;394(10200):746-756. doi: 10.1016/S0140-6736(19)31281-4. Epub 2019 Jul

  • ACL reconstruction vs rehab

    https://pubmed.ncbi.nlm.nih.gov/38940695/ ACL SNNAP Trial (Beard et al., 2022) Rehabilitation versus ACL Reconstruction for Persistent Instability 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,

  • Cartilage outcomes

    Recovery After Cartilage Treatment Evidence base Searle HKC, Raj S, Ridha A, Ahmed I, Khatri C, Metcalfe A, Smith N. The recovery trajectory of people undergoing treatment for knee articular cartilage damage: A systematic review and meta-analysis. Knee. 2025 Oct;56:211-223. doi: 10.1016/j.knee.2025.05.031. Epub 2025 Jun 4. PMID: 40472679. This study was conducted by our team

  • Meniscal allograft transplantation

    Nick Smith has published numerous research papers on meniscal allograft transplantation: He has published systematic reviews on the patient outcomes following transplant surgery, and also whether it reduces the risk of future osteoarthritis. These papers showed that on average, meniscal allograft transplantation improves results for patients. There is some early evidence that shows meniscal allograft

  • Meniscal transplant outcomes in patients with cartilage damage

    https://pubmed.ncbi.nlm.nih.gov/39506549/ Evidence base Ahmed I, Khatri C, Spalding T, Smith N. Meniscal allograft transplantation in patients with substantial cartilage disease led to a sustained long-term improvement in patient-reported outcome measures. Knee Surg Sports Traumatol Arthrosc. 2025 Aug;33(8):2771-2780. doi: 10.1002/ksa.12536. Epub 2024 Nov 7. PMID: 39506549. Key points Meniscal transplantation improves pain and function for up

  • Meniscal transplant return to sport

    https://pubmed.ncbi.nlm.nih.gov/41144796/ Evidence base Ahmed I, Khatri C, Davidescu A, Spalding T, Smith N. Returning to competitive sport after meniscal allograft transplant is associated with sustained graft survival and improved patient-reported outcomes. Knee Surg Sports Traumatol Arthrosc. 2025 Oct 27. doi: 10.1002/ksa.70137. Epub ahead of print. PMID: 41144796. Key points Returning to competitive sport after meniscal

  • Meniscal transplantation vs physiotherapy

    https://pubmed.ncbi.nlm.nih.gov/29305451/ Evidence base Smith NA, Parsons N, Wright D, Hutchinson C, Metcalfe A, Thompson P, Costa ML, Spalding T. A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment. Bone Joint J. 2018 Jan;100-B(1):56-63. doi: 10.1302/0301-620X.100B1.BJJ-2017-0918.R1. PMID: 29305451. Key points Meniscal transplantation improves pain and

  • Partial knee replacement

    Nick Smith has published the clinical outcomes following partial knee replacement using the newer Oxford Cementless partial knee implant.

  • Allografts in knee surgery

    https://pubmed.ncbi.nlm.nih.gov/30721344/ https://pubmed.ncbi.nlm.nih.gov/30903218/ https://pubmed.ncbi.nlm.nih.gov/30982109/ Nick Smith was involved in a programme of work looking at the clinical and cost effectiveness of allografts (donor tissue) in knee surgery. This was subdivided into four main projects: ACL reconstruction, PCL reconstruction, meniscal allograft transplantation and osteochondral allograft transplantation. Osteochondral allograft transplantation Osteochondral allograft transplantation (OCA) is a procedure where

  • Daycase knee replacement

    Nick Smith helped to introduce daycase partial knee and total hip replacement at South Warwick University NHS Foundation Trust and has published this experience. The implementation was successful and the results showed that patients were happy with their care. Clinical scores were similar between daycase patients and patients that previously stayed in hospital for longer.

Related Procedures

  • STABILITY Study (Getgood et al., 2020) Lateral Extra-articular Tenodesis (LET) in ACL Reconstruction 🔗 https://pubmed.ncbi.nlm.nih.gov/31940222/ Getgood AMJ, et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial. Am J Sports Med. 2020 Feb;48(2):285-297. doi: 10.1177/0363546519896333. Epub 2020 Jan 15. PMID: 31940222. Key

  • https://pubmed.ncbi.nlm.nih.gov/40690738/ Evidence base Ayuob A, Raj S, Jessup J, Searle HKC, Ahmed I, Thompson P, Shah F, Metcalfe A, Smith N. Introducing “Delta Angle” of Posterior Tibial Slope and Its Impact on ACL Reconstruction Failures: A Regression Analysis of 1174 Patients. Am J Sports Med. 2025 Aug;53(10):2387-2396. doi: 10.1177/03635465251355213. Epub 2025 Jul 21. PMID: 40690738.

  • One of the most important research projects in ACL reconstruction came from the STABILITY 1 trial, which was a randomised trial comparing ACL reconstruction with or without lateral extra-articular tenodesis (an extra part to the operation, in which a section of iliotibial band on the outside of the knee is connected in to the thigh

  • https://pubmed.ncbi.nlm.nih.gov/30721344/ https://pubmed.ncbi.nlm.nih.gov/30903218/ https://pubmed.ncbi.nlm.nih.gov/30982109/ Nick Smith was involved in a programme of work looking at the clinical and cost effectiveness of allografts (donor tissue) in knee surgery. This was subdivided into four main projects: ACL reconstruction, PCL reconstruction, meniscal allograft transplantation and osteochondral allograft transplantation. Osteochondral allograft transplantation Osteochondral allograft transplantation (OCA) is a procedure where

  • Nick Smith helped to introduce daycase partial knee and total hip replacement at South Warwick University NHS Foundation Trust and has published this experience. The implementation was successful and the results showed that patients were happy with their care. Clinical scores were similar between daycase patients and patients that previously stayed in hospital for longer.

  • https://pubmed.ncbi.nlm.nih.gov/35755791/ Diagnosis, Consequences and Treatment Evidence Base Banovetz MT, Roethke LC, Rodriguez AN, LaPrade RF. Meniscal Root Tears: A Decade of Research on their Relevant Anatomy, Biomechanics, Diagnosis, and Treatment. Arch Bone Jt Surg. 2022 May;10(5):366-380. doi: 10.22038/ABJS.2021.60054.2958. PMID: 35755791; PMCID: PMC9194705. Key Points Meniscal root tears are serious injuries that can behave like complete

  • https://pmc.ncbi.nlm.nih.gov/articles/PMC5765989/ Evidence base Dagneaux L, Bourlez J, Degeorge B, Canovas F. Return to sport after total or unicompartmental knee arthroplasty: an informative guide. EFORT Open Rev. 2017. This review summarises the current evidence on returning to sport after knee replacement, including both total knee replacement (TKR) and partial knee replacement (UKR). Key points Most patients

  • TOPKAT Trial – 5-Year Outcomes (Beard et al., 2019) Total vs Partial Knee Replacement for Medial Knee Arthritis 🔗 Beard DJ, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet. 2019 Aug 31;394(10200):746-756. doi: 10.1016/S0140-6736(19)31281-4. Epub 2019 Jul

  • Nick Smith has published numerous research papers on meniscal allograft transplantation: He has published systematic reviews on the patient outcomes following transplant surgery, and also whether it reduces the risk of future osteoarthritis. These papers showed that on average, meniscal allograft transplantation improves results for patients. There is some early evidence that shows meniscal allograft

  • Nick Smith has published the clinical outcomes following partial knee replacement using the newer Oxford Cementless partial knee implant.