PhD Overview - Breck Lord

Professor Adrian Wilson’s innovation and enthusiasm for clinical research was fundamental to my recently completed PhD. A large proportion of my thesis was dedicated to the novel techniques he has developed within his practice.

These techniques for graft preparation during anterior cruciate ligament reconstruction (ACLR) were investigated under the supervision of Professor Andrew Amis at Imperial College London and have been published in ‘Knee Surgery, Sports Traumatology & Arthroscopy’; the journal for the European Society of Sports Traumatology, Knee Surgery & Arthroscopy.

Many studies have suggested a superiority of double- over single-bundle ACLR; however, this is challenging and often results in complications. Much of the advantage of this technique is said to derive from having two sockets to cover the femoral ACL attachment.

Study 1 - simplified 3-socket system

The purpose of the first study was to investigate whether a simplified 3-socket technique, with only one tibial socket, would more closely restore native knee kinematics compared to single-bundle surgery. The novel construct was shown to be a viable, bone preserving, alternative to double-bundle surgery although no definitive superiority over single-bundle was shown.

A robotic testing system measured knee kinematics allowing comparison between the native joint and subsequent ACLR techniques. The robotic testing system was supported by the Wellcome Trust and EPSRC Centre of excellence for application for technology to osteoarthritis. 

Study 2 - compression downsizing

Compression downsizing provides an ACL graft of uniform size, allowing easy passage into a smaller tunnel minimising bone loss during ACLR. The purpose of this study was to identify effects on graft biomechanics, graft size and changes in graft stability. Materials testing machines and joint simulation were used to investigate this phenomenon in peroneus longus Bioclense® treated allograft tendons. 

Graft being downsized in compression tube

No detrimental biomechanical effects of graft compression on allograft tendons were observed. Following compression, the grafts significantly increased in size during in vitro joint simulation. No significant difference was observed in graft stability between groups. Graft compression did not cause adverse mechanical effects in-vitro. Smaller tunnels for compressed grafts reduce bone loss and ease anatomical placement.

Adrian Wilson

Breck has kindly given us a summary of his PhD, which was awarded 3 weeks ago. It was a mountain of work which he did at Imperial with Professor Amis.

He investigated my TriLink concept, which is a novel graft for ACL and PCL surgery employing 2 limbs on the femur and one on the tibia. He looked at the biomechanics using a robot and it was a monumental task. He did this with myself and Bhushan Sabnis who was my fellow at the time. There were many late nights doing reconstructions at Imperial College and I’m delighted to see that he has written up the work so well.

He also examined the biomechanical effects of graft compression and did a very elegant experiment which showed how the grafts reduced in size and then re-expanded.

I'm really proud of him and the work that he did.

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