Summary

The addition of the anterolateral ligament reconstruction may affect the maturation of the anterior cruciate ligament graft.

Abstract

Objective

To investigate whether additional anterolateral ligament (ALL) reconstruction affects signal intensity on the MRI of the anterior cruciate ligament (ACL) graft.

Methods

We examined 13 knees with isolated ACL reconstructions using quadrupled hamstring tendon grafts (the isolated group) and 45 knees with combined ACL and ALL reconstructions based on Sonnery-Cottet’s technique (the combined group) performed from 2016 to 2021. The statistical details for both groups are: the ages were 26.9±12.1 (mean±SD) and 22.6±7.6 (P=0.12); the Tegner activity scores were 7.15±0.6 and 7.44±0.7 (P=0.19); the Lysholm scores were 82.2±14.5 and 70.3±22.0 (P=0.07); subjective IKDC scores were 63.7±12.4 and 56.9±17.6 (P=0.20); the pivot shift grades were 1.5±0.5 and 2.2±0.5 (P<0.001), respectively. They were followed up by 3.0T-MRI at 1, 6, 12, and 24 months after surgery. Revision cases, multiple ligament reconstruction cases, and re-tear cases were excluded in this study. All of ACL grafts were quantified on oblique sagittal proton density weighted images along the ACL grafts, and the signal/noise quotient (SNQ) on the center of the graft was calculated as follows: SNQ = (Signal of ACL graft – Signal of PCL) / Signal of background.

Results

The SNQ at 1 month after surgery was 5.7±4.5 in the isolated group and 5.9±3.8 in the combined group (P=0.87). They were 13.3±5.9 and 9.9±7.2 at 6 months after surgery (P=0.12); 7.7±5.1 and 4.4±4.8 at 12 months after surgery (P=0.03); and 3.7±5.3 and 2.4±2.5 at 24 months after surgery (P=0.23), respectively. The SNQ at 12 months after surgery in the combined group was significantly lower than for the isolated group.

Conclusion

The addition of the ALL reconstruction may affect the maturation of the ACL graft.