Summary

This study investigates the impact of femoral and tibial tunnel positioning on graft tendon maturity in anatomic double-bundle ACL reconstruction. MRI was used to assess graft maturity via the Signal Intensity Ratio (SIR) at 12 months postoperatively. Results showed a significant correlation between anterior (shallow) tunnel positioning and reduced graft maturity, highlighting the importance of pr

Abstract

Introduction

Postoperative evaluation of graft tendons in anterior cruciate ligament (ACL) reconstruction is crucial for assessing procedural success and preventing re-injury. Magnetic resonance imaging (MRI) is commonly employed to evaluate graft maturity, a key outcome measure. This study examines the relationship between graft tendon maturity and tunnel positioning in ACL reconstruction, with a focus on identifying factors that promote graft maturation.

Materials And Methods

This study analyzed 83 knees (46 male, 37 female) that underwent primary anatomic double-bundle ACL reconstruction from January 2016 to December 2022 at our institution and affiliated hospitals. Twelve months postoperatively, MRI was used to assess graft maturity via the Signal Intensity Ratio (SIR) of the anteromedial bundle (AMB) and posterolateral bundle (PLB). Correlations between SIR and variables such as sex, age, anterior translation (KneeLax3), and tunnel positioning (femoral side using the Quadrant method, tibial side using Forsythe's method) were evaluated.

Results

There was no significant correlation between SIR and sex, age, or anterior translation. However, a positive correlation was found between femoral tunnel positioning and SIR for both AMB and PLB in the Deep/shallow direction. Notably, anterior (shallow) femoral tunnel placement was associated with reduced graft maturity.

Discussion

The study suggests that femoral tunnel positioning is a critical factor in graft tendon maturity, with anterior (shallow) placement leading to lower maturity in both AMB and PLB. These findings emphasize the necessity of precise tunnel creation during ACL reconstruction to enhance graft maturation.

Conclusion

Graft tendon maturity one year after ACL reconstruction is significantly correlated with femoral tunnel positioning. These results highlight the importance of meticulous surgical technique in optimizing graft outcomes and ensuring long-term success in ACL reconstruction.