Summary

Anterior cruciate ligament repair was a promising surgical technique with partial healing and good post-operative functional scores.

Abstract

Background

There is little literature conducting ACL repair with postoperative MRI healing potential, and there is no gold standard for measuring ACL healing on MRI.

The objective of this study is to illustrate postoperative ACL healing on MRI in ACL repair patients and to reveal pre and postoperative outcomes.

Method

Patients who were suspected of having ACL injuries were confirmed by an MRI.
Inclusion criteria
1. ACL complete tear patients
2. Age was not over 60 years
3. ACL complete tear, Sherman classification I, II, III

Exclusion criteria
1. Multi-ligamentous knee injury (grade 3)
2. Infected knee
3. Inflammatory arthritis
4. Full-thickness cartilage loss
5. Irreparable bucket handle meniscus

Preoperative data was collected including a physical examination of knee stability (range of motion, anterior drawer test, Lachman test, Pivot-shift test), Knee scoring (IKDC, Lysholm knee scoring scale), and MRI parameters (translation, angulation, cartilage and meniscus injuries in ACL repair patients). Operation for ACL repair was performed. After one year post-ACL repair, the postoperative scores were collected (same parameters as pre-operatively).

Results

10 patients received postoperative MRI and completed questionnaires and physical examinations. 9 people were male patients. The average age of the patients was 26.9 years. The average time from injury to ACL repair surgery was 67.1 days.
The average different range of deep flexion motions of ACL repaired knees and normal knees was 4.7 degrees.
All patients with ACL repair had increased signal intensity at ACL repair in an MRI. We could identify ACL fiber continuity in all patients (partial thickness).
The average IKDC scores were 17.239 and 78.618 for preoperative and postoperative scores respectively.
For the Lysholm score, the average preoperative Lysholm score was 35.4 and the average postoperative score was 82.1.
For the Tegner score, The patients reported average scores of 8.6 and 7 pre and postoperative periods respectively.

Discussion

This is one of very few studies that demonstrated patients who received ACL repair with clinical follow-ups and imaging study for a long period of post-operative time.
The MRI revealed all ten patients with ACL repair had healing signs from showing fiber continuity, although they were all partial thickness fiber continuity, not full thickness. All these ACL fibers had increased signal intensity which could imply that our ACL repair patients had partially healed.
As a result of plotting the graph between time injury to surgery (TTS) and Postoperative IKDC score, we can see the tendency that patients with low TTS to have high Postoperative IKDC scores. The graph also revealed the tendency that patients with low TTS to have high Postoperative IKDC scores. The higher preoperative Lysholm scores seem to have higher postoperative Lysholm scores.

Conclusion

Anterior cruciate ligament repair was a promising surgical technique with partial healing and a good post-operative functional score. Early time injury to surgery and higher preoperative Lysholm score may be parameters to predict postoperative functional outcomes in patients who performed anterior cruciate ligament repair.