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MRI After ACL Reconstruction Demonstrates that Hamstring Grafts Heal and Integrate at Different Rates

2021 Congress Paper Abstracts

MRI After ACL Reconstruction Demonstrates that Hamstring Grafts Heal and Integrate at Different Rates

Sven Edward Putnis, MBChB, FRCS(Orth), UNITED KINGDOM Takeshi Oshima, MD, PhD, JAPAN Antonio Klasan, MD, AUSTRIA Samuel Grasso, PhD, B. Engineering (Mechanical), AUSTRALIA Thomas Neri, MD, PhD, Asst. Prof., FRANCE Myles R. J. Coolican, FRACS, AUSTRALIA Brett A. Fritsch, MBBS BSc(Med), FRACS, FAOrthA, AUSTRALIA David A. Parker, MBBS, BMedSc, FRACS, AUSTRALIA

Sydney Orthopaedic Research Institute, Sydney, NSW, AUSTRALIA


2021 Congress   Abstract Presentation   6 minutes   rating (1)

 

Anatomic Location

Anatomic Structure

Diagnosis / Condition

Treatment / Technique

Ligaments

ACL

Patient Populations

Diagnosis Method

MRI

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Summary: New MRI analysis at 1 and 2 years after ACL reconstruction demonstrates that hamstring grafts heal and integrate at different rates


Purpose

To establish whether a hamstring ACL reconstruction graft changes in appearance on MRI between 1 and 2 years, and whether it affects a patient’s ability to return to sport.

Methods

Patients with a hamstring autograft ACL reconstruction using adjustable suspensory fixation had MRI and clinical outcome measures at 1 and minimum 2 years. Signal intensity ratio (SIR) at multiple areas using oblique reconstructions both parallel and perpendicular with the graft were calculated alongside tunnel aperture sizes. Clinical outcome was side to side anterior laxity, and patient reported outcome measures (PROMs).

Results

Forty-two patients had full datasets. At 1 year the mean SIR for the graft was 2.7 +/- 1.2, with proximal graft signal significantly higher than distal. Overall, there was no significant change at by 2 years apart from those with the highest proximal graft signal (SIR > 4) at 1 year. This group had a reduction in signal and were also most likely to have a reduction in tunnel aperture area. The finding of tunnel aperture area reduction between 1 and 2 years was significant across the full cohort (mean tibial -6.9mm2, p< 0.001, mean femoral -13.5mm2, p< 0.001). A high patient sporting level was seen, with a median Tegner activity score of 6 [5-10], with a third of patients scoring either a 9 or 10. Overall, PROMs were not affected by MRI appearance.

Conclusions

In the majority of patients graft signal does not change after one year. However, a significant reduction is seen in those with high signal at one year. Tunnel contraction correlates with a reduction in graft SIR suggesting this could be a useful measure of graft integration.


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