Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Health and Rehabilitation Sciences

Collaborative Specialization

Musculoskeletal Health Research

Supervisor

Bryant, Dianne

2nd Supervisor

Getgood, Alan

Co-Supervisor

Abstract

One hundred and ninety-six patients at the Fowler Kennedy Sport Medicine Clinic (FKSMC) undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) were randomized as part of the multi-center STABILITY study to receive either an isolated ACLR or ACLR with a lateral extra-articular tenodesis (LET). The STABILITY study followed these patients up to two years postoperative, and a long-term follow-up protocol was initiated afterwards. Eighty-two patients from this center were seen at three, five and seven years postoperative as part of a long-term follow-up. Our primary outcome was a composite outcome of instability and graft failure. Secondary outcomes included patient-reported outcome measures (PROMs), range of motion measurements, and adverse events. We found no statistically significant differences between groups for the composite outcome or the secondary outcomes, however there was a significant increase in graft rupture in the ACLR alone group. This thesis presents preliminary, single-center results of a long-term follow-up of the STABILITY study.

Summary for Lay Audience

Athletes participating in pivoting sports such as soccer and basketball have a high chance of injuring the anterior cruciate ligament (ACL) in their knees, leading to feelings of instability in the joint. The ACL is responsible for stabilizing the knee during movement, and ACL injuries are debilitating and can lead to long term consequences such as post-traumatic osteoarthritis (PTOA) if not treated properly. The standard approach to treat a torn ACL is an ACL reconstruction (ACLR) using one of the patient’s own tendons as a graft to replace the torn ACL inside the knee. However, previous research has shown high ACL re-tear rates in patients that return to pivoting sports after undergoing an ACLR. Clinicians began to explore other surgical techniques in an attempt to further reduce risk of re-injury and investigated the possibility of adding an extra procedure called a lateral extra-articular tenodesis (LET) to the ACL reconstruction. In order to determine if the extra procedure provided any benefits, the STABILITY study was conducted as a randomized clinical trial (RCT), where patients were randomized to receive either the ACLR alone, or ACLR with LET. Patients involved in this study were followed up to two years postoperatively.

The purpose of this thesis was to perform a long-term follow-up of patients involved in the STABILITY study (three, five and seven years postoperative). We asked patients to complete questionnaires about their knee function, and surgeons assessed their knee during a clinical examination. We did not find statistically significant differences between the groups for the outcome measures, however more patients in the ACLR alone group retore their ACL, compared to the ACLR with LET group. Long term outcomes are critical to understanding the benefits and consequences of surgical approaches for ACL reconstructions and can inform us of ways to improve techniques for the future.

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