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Sufficient MRI graft structural integrity at 9 months after anterior cruciate ligament reconstruction with hamstring tendon autograft

Knee Surgery, Sports Traumatology, Arthroscopy (2022)Cite this article

Abstract

Purpose

To assess the MRI-measured structural integrity of hamstring autograft at 9 months after anterior cruciate ligament reconstruction (ACLR) surgery.

Methods

A prospective cohort study was conducted including 34 patients (mean age 36.8 ± 11.8 years; 73.5% males) who underwent ACLR with hamstring autograft. In addition, 36 patients (mean age 39.2 ± 10.5 years; 69.4% males) without any ACL injury were also reviewed and served as control group. The primary outcome used for examining graft maturity at 9 months after ACLR was the MRI-based signal-to-noise quotient (SNQ) of reconstructed ACL. SNQ values were stratified into 3 different categories: excellent: < 0.1; good: ≥ 0.1 and ≤ 0.19; fair: ≥ 0.2. The KT-1000 knee arthrometer was used to measure the side-to-side difference in the anterior tibial translation between the ACLR knee and the contralateral healthy knee in the ACLR group.

Results

Reconstructed ACLs were found with a mean SNQ of 0.078 ± 0.061, while almost all ACL-reconstructed patients (97%; 33 out of 34) were found with excellent or good SNQ values (< 0.019). The mean KT-1000 in the ACLR group was 0.071 mm ± 0.926 mm, while there were no patients in the ACLR cohort with a KT-1000 value > 3 mm. The mean 9-months MRI-based SNQ of ACLR group was significantly higher compared to the mean MRI-based SNQ of the control group (p < 0.001). Multiple regression analysis showed no correlation between SNQ and age, gender, time from injury to ACLR, graft size, or simultaneous treatment of additional intra-articular knee lesions.

Conclusions

In this cohort of 34 ACL-reconstructed patients, 97% of hamstring tendon autografts demonstrated excellent/good MRI signal intensity and excellent functional results (KT-1000 < 3 mm) at 9 months after surgery. Based on this finding, it is suggested that return to sports after ACLR with hamstring autograft can be considered safe at 9 months post surgery. Furthermore, while structural integrity of the graft has been achieved at this time point, statistical differences found in SNQ values of ACL-reconstructed patients compared to ACLs of healthy individuals highlight the continuing process of graft maturation and remodelling.

Level of evidence

Level III.

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Abbreviations

RTS:

Return to sport

ACLR:

Anterior cruciate ligament reconstruction

ACL:

Anterior cruciate ligament

SNQ:

Signal-to-noise quotient

BPTB:

Bone–patellar–tendon–bone

ROM:

Range of motion

ROI:

Region of interest

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Funding

The authors declare that they have had no funding source for doing this research work.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Clinical Ars Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland

    Michael-Alexander Malahias, Francesco Maria Capece, Marco Marano, Danilo Togninalli & Matteo Denti

  2. Department of Radiology, Clinical Ars Medica, Gravesano, Ticino, Switzerland

    Claudio Ballarati

  3. IRCCS Istituto Ortopedico Galeazzi, Milano, Italy

    Marco Viganò, Laura de Girolamo & Matteo Denti

  4. Medical University of Vienna, Wien, Austria

    Marcus Hofbauer

  5. University of Rome ‘Tor Vergata’, Rome, Italy

    Francesco Maria Capece

Authors
  1. Michael-Alexander Malahias
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  2. Francesco Maria Capece
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  3. Claudio Ballarati
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  4. Marco Viganò
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  5. Marco Marano
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  6. Marcus Hofbauer
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  7. Danilo Togninalli
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  8. Laura de Girolamo
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  9. Matteo Denti
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Contributions

MM wrote the manuscript, participated in the conception and design of the study and in the interpretation of data and participated in the ACL reconstructions. FC critically revised and edited the manuscript, participated in the acquisition of data, and assisted during the operations. CB analyzed MRI images participated in the acquisition of data and critically revised the manuscript. MV participated in the conception and design of the study. MM and LG statistically analyzed the data and critically revised and edited the manuscript. MH and DT conceived the study and participated in its design. MD conceived the study and participated in its design and coordination, carried out all the operations and had the final checking of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Francesco Maria Capece.

Ethics declarations

Conflict of interest

MM, FC, CB, MM, LG, MH, DT, MD declare that they have no competing interests. MV is a paid consultant of Lipogem SpA.

Ethical approval

Institutional review board approval for the study was provided by the Medical University of Vienna (no. 1562–2014).

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Malahias, MA., Capece, F.M., Ballarati, C. et al. Sufficient MRI graft structural integrity at 9 months after anterior cruciate ligament reconstruction with hamstring tendon autograft. Knee Surg Sports Traumatol Arthrosc (2022). https://doi.org/10.1007/s00167-021-06830-2

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  • DOI: https://doi.org/10.1007/s00167-021-06830-2

Keywords

  • ACL reconstruction
  • Graft healing
  • Hamstring tendon
  • Return to sports
  • MRI
  • Signal-to-noise quotient
  • KT-1000 arthrometer