Sadesh Balasingam: Long-term outcomes of ACL surgery
Anterior Cruciate Ligament (ACL) injuries are among the most researched topics in orthopaedics, yet long-term outcomes after surgery are less understood. Sadesh Balasingam’s research focuses on comparing ACL surgery methods over time, exploring patient satisfaction and the development of osteoarthritis in the years following surgery.
SADESH BALASINGAM
Dissertation defense: 22 November 2024 (click for details)
Doctoral thesis: Evaluation of long-term outcomes after anterior cruciate ligament reconstruction. Operative methods, clinical and radiological findings, and their relationship to patient-reported acceptable knee function
Research area: Orthopaedics
Sahlgrenska Academy, The Institute of Clinical Sciences
ACL injuries often require surgical intervention, but while much is known about short-term recovery, fewer studies focus on results beyond 10 years post-surgery.
“An ACL graft is for life, not just for Christmas,” Sadesh Balasingam remarks, paraphrasing an English saying.
What is the background of your research?
“We wanted to look at different methods and factors that affect outcomes for patients more in the long-term rather than just the first few years,” says Balasingam, a sports medicine doctor and team physician for Swedish top division football club BK Häcken and the Swedish women’s national football team.
Focus on patient satisfaction
His research focused on how osteoarthritis develops and how satisfied patients were with their surgeries. One study also examined the use of a biocomposite screw designed to minimize bone loss caused by bone’s reaction to metallic screws in surgical drill holes, as well as the impact of additional injuries such as damage to the meniscus, cartilage, or both.
What are the most important findings?
“Patients with both meniscus and cartilage injuries at the time of ACL surgery experienced greater declines in knee function over time,” Balasingam explains.
Double-bundle not better
The study also found no significant difference between the “double-bundle” and “single-bundle” ACL reconstruction methods, even though the double-bundle method was thought to be an improvement.
“Given the ‘double-bundle’ method is harder to do and more expensive, it has now fallen out of favour in Sweden,” he says.
Balasingam’s team also addressed patient satisfaction, an area often overlooked in ACL research. Rather than just relying on scores from questionnaires, they asked patients outright if they were satisfied with their surgery.
“This allowed us to define clearer cut-off values for what patients consider a ‘good’ outcome that can be used to better interpret Swedish ACL research now and in the future,” says Balasingam, noting that Swedish patients’ cut-off values differed slightly from American and Norwegian studies, suggesting potential cultural differences in patient satisfaction.
May provide refined approaches
The study’s findings may help surgeons refine their approaches and offer patients clearer expectations for recovery, particularly for those with additional injuries. It also provides data that could shape future ACL surgery protocols.
What has been the most rewarding part of your doctoral project?
“Presenting at international conferences has been a highlight. It is a great way to connect and gain new perspectives. Being a researcher has definitely helped open a lot of doors, both in that sphere but even professionally as a doctor,” says Sadesh Balasingam.
And the most challenging?
“Juggling other commitments to make time to focus on research work has probably been the greatest challenge. So, I’ve been very reliant on flexibility and understanding from colleagues, my supervisors and most of all my family. I worked on my thesis in at least 17 different countries while traveling with teams. New Zealand had the best coffee, but Swedish fika will probably always come out on top for writing fuel.”
Text: Jakob Lundberg