Anterior cruciate ligament grafts display differential maturation patterns on magnetic resonance imaging following reconstruction: a systematic review

Abstract

Purpose

The appearance of anterior cruciate ligament (ACL) grafts on magnetic resonance imaging (MRI) is related to graft maturity and mechanical strength after ACL reconstruction (ACLR). Accordingly, the purpose of this review was to quantitatively analyze reports of serial MRI of the ACL graft during the first year following ACLR; the hypothesis tested was that normalized MRI signal intensity would differ significantly by ACL graft type, graft source, and postoperative time.

Methods

PubMed, Scopus, and CINAHL were searched for all studies published prior to June 2018 reporting MRI signal intensity of the ACL graft at multiple time points during the first postoperative year after ACLR. Signal intensity values at 6 and 12 months post-ACLR were normalized to initial measurements and analyzed using a least-squares regression model to study the independent variables of postoperative time, graft type, and graft source on the normalized MRI signal intensity.

Results

An effect of graft type (P = 0.001) with interactions of graft type * time (P = 0.012) and graft source * time (P = 0.001) were observed. Post hoc analyses revealed greater predicted normalized MRI signal intensity of patellar tendon autografts than both hamstring (P = 0.008) and hamstring with remnant preservation (P = 0.001) autografts at postoperative month 12.

Conclusion

MRI signal varies with graft type, graft source, and time after ACLR. Enhanced graft maturity during the first postoperative year was associated with hamstring autografts, with and without remnant preservation. Serial MRI imaging during the first postoperative year may be clinically useful to identify biologically or mechanically deficient ACL grafts at risk for failure.

Level of evidence

IV

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Abbreviations

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

MRI:

Magnetic resonance imaging

BPTB:

Bone–patellar tendon–bone graft

HS:

Hamstring graft

HS-RP:

Hamstring graft with minimal debridement/remnant preservation surgical technique

TA:

Tibialis anterior graft

QUAD:

Quadriceps bone graft

ANOVA:

Analysis of variance

CI:

Confidence interval

SNQ:

Signal-to-noise quotient

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Affiliations

Authors

Contributions

TEH conceived the study, participated in the critical evaluation of the data and drafting of the manuscript. KEW participated in the critical evaluation of the data and drafting of the manuscript. JAP conducted the literature review, performed the critical evaluation of the data, and participated in the drafting and revision of the manuscript.

Corresponding author

Correspondence to Timothy E. Hewett.

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The authors declare that they have no conflict of interest.

Funding

Funding was provided by National Institute of Arthritis and Musculoskeletal and Skin Diseases (Grant Nos. R01AR55563, R01AR056259 and T32AR56950).

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Ethical approval was not required as this is a review of the literature not involving humans or animals.

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Panos, J.A., Webster, K.E. & Hewett, T.E. Anterior cruciate ligament grafts display differential maturation patterns on magnetic resonance imaging following reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 28, 2124–2138 (2020). https://doi.org/10.1007/s00167-019-05685-y

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Keywords

  • Anterior cruciate ligament
  • Magnetic resonance imaging
  • Signal–noise-quotient
  • Ligamentization