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dc.contributor.authorHughes, Jonathan
dc.date.accessioned2024-04-15T07:21:52Z
dc.date.available2024-04-15T07:21:52Z
dc.date.issued2024-04-15
dc.identifier.isbn978-91-8069-673-9 (TRYCK)
dc.identifier.isbn978-91-8069-674-6 (PDF)
dc.identifier.urihttps://hdl.handle.net/2077/80184
dc.description.abstractAnterior cruciate ligament (ACL) injuries are becoming increasingly common and can have a detrimental effect on patients and their activities. Anatomic ACL reconstruction remains the gold standard for treatment. While various non-modifiable and modifiable risk factors for ACL injuries and ACL graft failures have been identified, failure rates still remain unacceptably high, possibly due to un-identified patient bony morphological factors as well as surgical technique and expertise. This thesis consists of six studies with an overall aim to identify technical and previously unknown bony morphological risk factors for ACL tears and ACL graft failure. Study 1 evaluates the relationship of femoral tunnel position and risk of revision ACL reconstruction. This study found an increased risk of revision ACL reconstruction in patients with more anterior and proximal (high) femoral tunnels. Additionally, in those patients undergoing revision ACL reconstruction, patients who had a non-traumatic failure had more anteriorly-placed femoral tunnels than those patients who had a traumatic failure. These findings highlight the importance of proper femoral tunnel placement during ACL reconstruction, as even a slight deviation from anatomic placement can place the patient at an increased risk to undergo revision ACL reconstruction. Study 2 assesses femoral and tibial tunnel position after ACL reconstruction and risk for recurrent or de novo meniscus tears postoperatively. This study found an increased risk of recurrent or de novo meniscus tears after index ACL reconstruction in patients with anteriorly-placed femoral tunnels. These results demonstrate the importance of anatomic tunnel placement on the femoral side after ACL reconstruction. Study 3 examines how surgeon volume effects femoral and tibial tunnel placement after ACL reconstruction. This study showed low-volume surgeons placed their femoral and tibial tunnels significantly more anterior and proximal (high) and posterior, respectively, during ACL reconstruction compared to high-volume surgeons. These results demonstrate the importance of surgical volume and expertise during ACL reconstruction, as non-anatomic tunnel placement can lead to subsequent revision ACL reconstruction and/or recurrent or de novo meniscus tears. Study 4 investigates the role of posterolateral tibial plateau fractures on rotatory knee laxity after ACL injury. This study found that posterolateral tibial plateau impaction fractures do not significantly increase rotatory knee laxity based on subjective and objective peri-operative examination. These findings suggest that posterolateral tibial plateau impaction fractures do not need to be addressed at the time of ACL reconstruction and further causes of increased rotatory knee laxity need to be elucidated. Study 5 evaluates the role of the intercondylar notch width with ACL graft failure. This study found that intercondylar notch width was associated with ACL graft failure. Specifically, an intercondylar notch size less than 16mm had an odds ratio of 5.0 for ACL graft failure, while an intercondylar notch size less than 15mm had an odds ratio of 5.6 for ACL graft failure. While the intercondylar notch size is a non-modifiable risk factor, patients with this risk factor should be counseled appropriately regarding their increased risk of ACL graft failure. Study 6 compares patient-reported and clinical outcomes in patients undergoing ACL reconstruction with all soft tissue quadriceps tendon autograft (sQT) and quadriceps tendon autograft with bone graft (bQT). This study found no difference in patient-reported nor clinical outcomes between patients undergoing ACL reconstruction with sQT compared with bQT. The rate of ACL graft failure was 5% and 6% in the sQT and bQT groups, respectively. Additionally, the time and rate of return to sport were similar between the two groups. These findings indicate either preparation of the quadriceps tendon autograft can be chosen based on patient preference, risk factors, and activity level. The main findings of this thesis are tunnel position and surgeon volume can affect postoperative outcomes and failure rates after ACL reconstruction, there are equivalent outcomes between sQT and bQT autografts in ACL reconstruction, posterolateral tibial plateau fractures and intercondylar notch width do not affect clinical outcomes, and a smaller intercondylar notch width is associated with increased ACL graft failures. These findings will assist the treating surgeon in providing an individualized approach to anatomic ACL reconstruction while avoiding pitfalls that may lead to postoperative complications including ACL graft failure. Key Words: ACL reconstruction, tunnel position, failure, surgeon volume, quadriceps tendon, notch widthsv
dc.language.isoengsv
dc.relation.haspartI. Byrne K, Hughes JD, Gibbs CM, Vaswani R, Meredith SJ, Popchak AJ, Lesniak BP, Karlsson J, Irrgang JJ, Musahl V. “Non-Anatomic Tunnel Position Increases the Risk of Revision Anterior Cruciate Ligament Reconstruction.” Knee Surg Sports Traumatol Arthrosc. 2022 Apr;30(4):1388- 1395. https://doi.org/10.1007/s00167-021-06607-7sv
dc.relation.haspartII. Hughes JD, Gabrielli AS, Dalton JF, Raines BT, Dewald D, Musahl V, Lesniak BP. “More anterior placement of femoral tunnel position in ACL-R is associated with postoperative meniscus tears.” J Exp Orthop. 2023 Jun 30;10(1):66. https://doi.org/10.1186/s40634-023-00630-ysv
dc.relation.haspartIII. Hughes JD, Gibbs CM, Almast A, Atte A, Sansone M, Karlsson J, Musahl V. “More Anatomic Tunnel Placement for Anterior Cruciate Ligament Reconstruction by Surgeons with High-Volume Compared to Low-Volume.” Knee Surg Sports Traumatol Arthrosc. 2022 Jun;30(6):2014-2019. https://doi.org/10.1007/s00167-022-06875-xsv
dc.relation.haspartIV. Godshaw BM, Hughes JD, Lucidi GA, Setliff J, Sansone M, Karlsson J, Musahl V. “Posterior Tibial Plateau Impaction Fractures Are Not Associated With Increased Knee Instability: A Quantitative Pivot Shift Analysis.” Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):2998-3006. https://doi.org/10.1007/s00167-023-07312-3sv
dc.relation.haspartV. Hughes JD, Boden RA, Belayneh R, Dvorsky J, Mirvish A, Godshaw BM, Sansone M, Karlsson J, Musahl V. “Smaller Intercondylar Notch Size is Associated with Graft Failure after Anterior Cruciate Ligament Reconstruction.” Orthop J Sports Med 2024. In Press.sv
dc.relation.haspartVI. Setliff JC, Nazzal EM, Drain NP, Herman ZJ, Mirvish AB, Smith C, Lesniak BP, Musahl V, Hughes JD. “Anterior cruciate ligament reconstruction with all-soft tissue quadriceps tendon versus quadriceps tendon with bone block.” Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):2844- 2851. https://doi.org/10.1007/s00167-022-07254-2sv
dc.subjectACL reconstructionsv
dc.subjecttunnel positionsv
dc.subjectfailuresv
dc.subjectsurgeon volumesv
dc.subjectquadriceps tendonsv
dc.subjectnotch widthsv
dc.titleRelationship of Surgical Technique and Bony Morphology on Anterior Cruciate Ligament (ACL) Failure- Effect of Surgical Volume on Surgical Techniquesv
dc.typetexteng
dc.type.svepDoctoral thesiseng
dc.gup.mailhughesjd3@upmc.edusv
dc.type.degreeDoctor of Philosophy (Medicine)sv
dc.gup.originUniversity of Gothenburg. Sahlgrenska Academysv
dc.gup.departmentInstitute of Clinical Sciences. Department of Orthopaedicssv
dc.gup.defenceplaceMåndagen den 13 maj 2024, kl. 9.00, R-aulan, R-huset, Sahlgrenska Universitetssjukhuset/Mölndals sjukhus, Mölndalsv
dc.gup.defencedate2024-05-13
dc.gup.dissdb-fakultetSA


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