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Inferior graft maturity in the PL bundle after autograft hamstring double-bundle ACL reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate the signal/noise quotient (SNQ) for graft maturation and the serial changes observed in the magnetic resonance imaging (MRI) findings after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using a hamstring tendon autograft at a minimum of 5 years after surgery.

Methods

Forty-five patients who underwent DB ACL reconstruction between 2007 and 2010 were included in this prospective study. All participants underwent postoperative MRI at 3 weeks and 3, 6, 9 and 12, 18, 24, 36, 48 and 50 months. The signal intensity (SI) characteristics of the reconstructed graft were evaluated on oblique axial proton density-weighted MR imaging (PDWI) perpendicular to the grafts. The signal/noise quotient (SNQ) was calculated to quantitatively determine the normalized SI. The SNQ of the AMB and PLB was evaluated separately.

Results

The mean SNQ of the AM bundle (AMB) continued to increase until 6 months after surgery (5.2 ± 1.2), and then gradually decreased and became well stabilized by 18 months (3.3 ± 0.5), after which it remained unchanged. On the other hand, the mean SNQ of the PL bundle (PLB) continued to increase until 9 months after surgery (6.2 ± 1.1), and then decreased incrementally and became well stabilized by 24 months (4.1 ± 0.5). The SI of PLB was significantly higher than that of AMB between 3 and 24 months (p = 0.04, 0.03, 0.01, 0.04, 0.02 and 0.03, respectively).

Conclusions

These results indicate that at least 18 months is needed after ACL reconstruction to sufficiently restore the SI of the AMB, while at least 24 months are needed to for the PLB. The SI of the PLB was significantly higher than that of the AMB at 3–24 months after surgery, indicating that the PLB showed inferior graft maturity to the AMB until 24 months after surgery. For clinical relevance, the correct understanding of serial changes in graft maturation may potentially be used in decision-making regarding a return to sports.

Level of evidence

Prospective case series, Level IV.

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Abbreviations

ACL:

Anterior cruciate ligament

PCL:

Posterior cruciate ligament

AM:

Anteromedial

PL:

Posterolateral

SNQ:

The signal/noise quotient

SI:

Signal intensity

PDWI:

Proton density-weighted images

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Authors and Affiliations

  1. Funabashi Orthopaedic Hospital Sports Medicine Center, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan

    Hideaki Fukuda, Shigehiro Asai, Izumi Kanisawa, Tatsuya Takahashi, Takahiro Ogura, Hiroki Sakai, Kenji Takahashi & Akihiro Tsuchiya

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  1. Hideaki Fukuda
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  2. Shigehiro Asai
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  3. Izumi Kanisawa
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Correspondence to Hideaki Fukuda.

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Fukuda, H., Asai, S., Kanisawa, I. et al. Inferior graft maturity in the PL bundle after autograft hamstring double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 491–497 (2019). https://doi.org/10.1007/s00167-018-5087-z

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  • DOI: https://doi.org/10.1007/s00167-018-5087-z

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