La radiologia medica

, Volume 116, Issue 7, pp 1124–1133 | Cite as

MR in the evaluation of new anterior cruciate ligament and tibial tunnel position: correlation with clinical and functional features

  • N. MagarelliEmail author
  • C. Carducci
  • G. Cannataro
  • G. Graziano
  • A. Leone
  • D. Palmieri
  • M. Barbato
  • F. Ciampa
  • L. Bonomo
Musculoskeletal Radiology / Radiologia Muscoloscheletrica



This study aimed to evaluate correlations between the position of the tibial tunnel, its alignment with the ligament-screw system, presence of intratunnel fluid, position of the tibial tunnel with respect to the Blumensaat line and clinical knee stability in patients who underwent arthroscopic reconstruction of the anterior cruciate ligament (ACL), by using magnetic resonance (MR) imaging.

Materials and methods

Forty-eight patients (40 men, eight women; mean age, 31 years) underwent arthroscopic reconstruction of the ACL using double-strand semitendinosus and gracilis tendons. The new ACL was fixed to the tibial tunnel using Bio-Intrafix (Mitek). All patients underwent MR imaging 12 months after surgery and clinical evaluation at 6 and 12 months using the International Knee Documentation Committee (IKDC) scoring system. MR imaging and clinical features were correlated using the Mann-Whitney U test for continuous variables and Fisher’s exact test for categorical variables.


Forty-one patients were clinically stable (groups A and B according to the IKDC test) and seven were unstable (group C). Mean values of tibial tunnel position in clinically unstable vs stable patients were, respectively, −3.6 ±3.8 mm vs. −2.8±3.8 mm in relation to the Blumensaat line (p=0.5712) and 77.3°±11.3 vs. 72.5°±5.5 necesas concerned the angle measured on the coronal view of the new ACL (p=0.3248); fluid was present in the tibial tunnel in 42.9% and 9.8% of cases, respectively (p=0.2104). MR imaging showed misalignment of ligament screw and tibial tunnel in 57.1% of patients in group C and in 12.2% in groups A and B (p=0.017).


Misalignment of the ligament-screw system and the tibial tunnel and the presence of fluid in the tibial tunnel appear to be directly correlated with clinical instability.


Knee MR imaging Anterior cruciate ligament Tibial tunnel 

La RM nella valutazione del nuovo legamento crociato anteriore e della posizione del tunnel tibiale: correlazione con le caratteristiche cliniche e funzionali



Scopo del nostro lavoro è stato valutare le correlazioni tra la posizione del tunnel tibiale, il suo allineamento con il sistema vite-camicia-legamento, la presenza di fluido nel tunnel, la posizione del tunnel tibiale rispetto alla linea di Blumensaat ed i segni clinici di stabilità del ginocchio in pazienti sottoposti a ricostruzione artroscopica del legamento crociato anteriore (LCA), utilizzando la risonanza magnetica (RM) quale metodica d’indagine.

Materiali e metodi

Quarantotto pazienti (40 uomini e 8 donne, età media: 31 anni) sono stati sottoposti a ricostruzione artroscopica del LCA, utilizzando i tendini semitendinoso e gracile (DGST). Il nuovo LCA è stato fissato al tunnel tibiale, utilizzando come dispositivo il Bio-Intrafix (Mitek). Tutti i pazienti sono stati sottoposti ad esame RM, sono stati valutati 12 mesi dopo l’intervento chirurgico e valutati clinicamente a 6 e 12 mesi, in accordo con l’International Knee Documentation Commitee Scoring (IKCD test). Gli aspetti RM e quelli clinici sono stati correlati tra loro, utilizzando il Mann-Whitney U test per le variabili continue e il Fisher test per le variabili categoriche.


Clinicamente, 41 pazienti sono risultati stabili (gruppo A e B del test IKDC) e 7 instabili (gruppo C). I valori medi della posizione del tunnel tibiale nei pazienti clinicamente instabili vs. i pazienti stabili sono stati rispettivamente −3,6±3,8 mm vs. −2,8±3,8 mm rispetto alla linea di Blumensaat (p=0,5712) e 77,3°±11,3° vs. 72,5°±5,5° per l’angolo calcolato sull’immagine coronale del nuovo LCA (p=0,3248); era presente fluido nel tunnel tibiale rispettivamente nel 42,9% e nel 9,8% (p=0,2104). Le immagini RM hanno mostrato un disallineamento del sistema vite-camicia-legamento rispetto al tunnel tibiale nel 57,1% dei pazienti nel gruppo C e nel 12,2% nei gruppi A e B (p=0,017).


Il disallineamento del sistema rispetto al tunnel tibiale e la presenza del liquido nel tunnel sembrano essere direttamente correlati con l’instabilità clinica.

Parole chiave

Ginocchio RM Legamento crociato anteriore Tunnel tibiale 


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Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • N. Magarelli
    • 1
    Email author
  • C. Carducci
    • 1
  • G. Cannataro
    • 2
  • G. Graziano
    • 3
  • A. Leone
    • 1
  • D. Palmieri
    • 4
  • M. Barbato
    • 4
  • F. Ciampa
    • 4
  • L. Bonomo
    • 1
  1. 1.Dipartimento di Bioimmagini e Scienze Radiologiche, Istituto di RadiologiaUniversità Cattolica del Sacro Cuore, Policlinico “A. Gemelli”RomaItaly
  2. 2.Unità Operativa di RadiodiagnosticaOspedale Civile “Del Ceppo”PistoiaItaly
  3. 3.Unità di Biostatistica, Dipartimento di Farmacologia Clinica ed EpidemiologiaConsorzio Mario Negri SudSanta Maria Imbaro (CH)Italy
  4. 4.Unità Operativa di Ortopedia e TraumatologiaOspedale “G. Bernabeo”OrtonaItaly

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