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Thesis
The Anterior Cruciate Ligament: MRI review of ACL reconstruction 9 months post-surgery with comparison of 4 surgical techniques
University of the Sunshine Coast, Queensland
Master of Sport and Exercise Science by Research, University of the Sunshine Coast, Queensland
2025
DOI:
https://doi.org/10.25907/00964
Abstract
Anterior Cruciate Ligament (ACL) injury is a relatively common but devastating event that occurs during sport and activities of everyday living. It is evident that extrinsic factors such as surgical technique and graft type can play a large role in rehabilitation post-surgery. However, it is still largely unknown whether ligamentisation should be part of this criteria or if it is even indicative of functional and subjective outcomes. There is also insufficient knowledge of the graft types best suited to achieve early ligamentisation. Accordingly, the primary aim of this thesis is to compare four ACLR techniques to determine how they may impact ligamentisation of an ACLR at 9 months post-surgery. These techniques include ACL remnant repair, standard 4 strand hamstring, short graft using Tape Locking Screw (TLS) and Bone Patellar Tendon Bone (BPTB) grafts. In addition, the project will aim to identify whether there is correlation between patient recorded outcome measures (PROMs) and ligamentisation scores on MRI across the four surgical techniques. An addition side question is to establish whether ACLR graft type affects the incidence of cyclops lesions. The data set consisted of 168 patients with an average patient age of 27.3 11.8 years. The sample consisted of 81 males and 87 females. Participants were divided into four groups based on the nature of the ACLR procedures, with 22 patients in the BPTB group, 42 patients in the 6-strand short graft group, 67 patients in the 4-strand hamstring group and 37 patients in the remnant repair group. In addition of the overall sample, 95 patients had meniscal repair, 88 had notchplasty and 18 had an additional LET procedure. Within the PROMS scores, 115 patients completed TEGNER and WOMAC, 114 completed IKDC, 116 completed OXFORD and 108 completed KOOS. All patients had their 9-month post-surgery MRI taken on a T3 scanner. The radiologist evaluated all patient scans at approximately 9 months post-surgery (mean = 269.33 days or 8.85 months post-operation) to find the diameter (mm), area (mm2) and Signal Noise Quotient (SNQ). SNQ scores were not significantly affected by any of the graft types, with no significant correlations found between SNQ and post-operation PROMs (r values ranging between .02 to .14 and P values between .87 to .15). All patients made a significant improvement in PROMs score from pre-operation to 9 months post-operation across all graft types (P = <.001). There were no significant findings on the change in pre-operation to post-operation PROMs (P values ranging between .77 to .29). Analysis of both the radiologist’s and surgeon’s data indicated no relationship between cyclops lesions occurring and a specific graft type (P = .98 and .22 respectively). Overall this study showed that, in this cohort of patients, the graft procedure chosen by the surgeon did not influence ligamentisation or PROMs. It would appear that the surgeon’s clinical reasoning surrounding graft choice is allowing for all patients to have a positive outcome. However, the large inter and intra-group differences means that a considerably larger cohort of participants would be required to draw meaningful conclusions about the influence of graft type many of the variables assessed in this study.
Details
- Title
- The Anterior Cruciate Ligament: MRI review of ACL reconstruction 9 months post-surgery with comparison of 4 surgical techniques
- Authors
- Calista Theron - University of the Sunshine Coast, Queensland, External
- Contributors
- Mark Sayers (Principal Supervisor) - University of the Sunshine Coast, Queensland, School of Health - Sports & Exercise ScienceMax Stuelcken (Co-Supervisor) - University of the Sunshine Coast, Queensland, Healthy Ageing Research Cluster
- Awarding institution
- University of the Sunshine Coast, Queensland
- Degree awarded
- Master of Sport and Exercise Science by Research
- Publisher
- University of the Sunshine Coast, Queensland
- DOI
- 10.25907/00964
- Organisation Unit
- School of Health
- Language
- English
- Record Identifier
- 991169245802621
- Output Type
- Thesis
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