Thesis on anterior cruciate ligament injury

“An anterior cruciate ligament injury (ACL injury) is a serious knee injury that primarily affects young and physically active individuals and can have long-term consequences for knee function, work capacity, and quality of life. Each year, a large number of patients in Sweden undergo surgical reconstruction of the injured ligament (ACL reconstruction), and this is the focus of my thesis”, says Dzan Rizvanovic, doctoral student at the Sports Medicine research group at the Department of Molecular Medicine and Surgery, Karolinska Institutet and specialist in orthopaedic surgery at Capio Artro Clinic.

“Using data from the Swedish Knee Ligament Registry, we studied tens of thousands of patients to investigate which factors are associated with different treatment strategies, and how these in turn relate to patients’ perceived knee function and the need for further surgery (revision). The thesis also has a particular focus on how the surgical volume of both the surgeon and the clinic is associated with treatment choices and outcomes”.

Which are the most important results?

“The main findings show that treatment strategies in ACL reconstruction are not solely related to the patient’s injury, but also to organizational factors. Surgeons and clinics with higher surgical volume are more likely to use different types of grafts (tendons used to replace the injured ligament), which may increase the opportunity for individualized treatment. They also repair meniscal injuries more frequently, a strategy that has been shown to be beneficial for long-term knee health. The management of cartilage injuries is also partly influenced by surgical volume”.

“Patients operated on by high-volume surgeons report better knee function two years after surgery and experience shorter waiting times from injury to surgery as well as shorter operative times. In contrast, the need for additional ACL reconstruction in the same knee is more related to patient- and injury-factors than to surgical volume”.

“The thesis also shows that graft choice influences subjective knee function at two years after surgery, particularly among females, which is an important finding”. 

How can this new knowledge contribute to the improvement of people’s health?

“This knowledge can contribute to more equitable and individualized care. By clarifying how surgical experience and surgical volume are associated with treatment decisions and outcomes, healthcare systems can better organize resources and create conditions for strengthened competence and improved decision-making in ACL reconstruction”.

“The results can also be used in the dialogue between patient and surgeon to select the treatment that best matches the individual’s needs and circumstances, which in the long term may improve knee function and increase quality of life in this young and working-age population”.

“Furthermore, the results from this thesis highlight the need for discussion regarding clearer national guidelines for referral pathways, minimum surgical volume requirements, and follow-up of treatment outcomes. It is also important that reporting to national quality registers is complete and made mandatory in order to enable transparency and continuous quality improvement”.

What are your future ambitions? 

“I hope to continue combining research with my clinical work to drive development forward and contribute to ensuring that patients with knee and sports-related injuries receive the best possible treatment. I also aim to contribute to a more equitable organization of healthcare, in which access to the right expertise at the right time does not depend on where in the country a patient lives”, says Dzan Rizvanovic.