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Diffusion tensor imaging of the anterior cruciate ligament graft following reconstruction: a longitudinal study

  • Musculoskeletal
  • Published:
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Abstract

Objective

To longitudinally monitor remodeling of human autograft following anterior cruciate ligament (ACL) reconstruction with DTI.

Methods

Twenty-eight patients underwent DTI follow-up at 3, 8, and 14 months after clinically successful ACL reconstruction with tendon autograft. Among these, 18 patients had a concomitant lateral extra-articular procedure (LET). DTI data from 7 healthy volunteers was also obtained. Diffusion parameters (fractional anisotropy, FA; mean diffusivity, MD; axial diffusivity, AD; and radial diffusivity, RD) were evaluated within the fiber tractography volumes of the ACL graft and posterior cruciate ligament (PCL) in all patients. Data were analyzed using a linear mixed-effects model with post hoc testing using Bonferroni-Holm correction for multiple testing. The effect of additional LET was studied.

Results

The ACL graft showed a significant decrease of FA over time (F = 4.00, p = 0.025), while the diffusivities did not significantly change over time. For PCL there were no significant DTI changes over time. A different evolution over time between patients with and without LET was noted for all diffusivity values of the ACL graft with reduced AD values in patients with LET at 8 months postoperatively (p = 0.048; adjusted p = 0.387). DTI metrics of the ACL graft differed largely from both native ACL and tendon at 14 months postoperatively.

Conclusion

Our study has shown the potential of DTI to longitudinally monitor the remodeling process in human ACL reconstruction. DTI analysis indicates that graft remodeling is incomplete at 14 months postoperatively.

Key Points

• DTI can be used to longitudinally monitor the remodeling process in human ACL reconstruction.

• DTI analysis indicates that autograft remodeling is incomplete at 14 months postoperatively.

• DTI may be helpful for evaluating new ACL treatments.

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Abbreviations

ACL:

Anterior cruciate ligament

AD:

Axial diffusivity

FA:

Fractional anisotropy

LET:

Lateral extra-articular tenodesis

MD:

Mean diffusivity

PCL:

Posterior cruciate ligament

PT:

Patellar tendon

RD:

Radial diffusivity

ST:

Semitendinosus tendon

DTI:

Diffusion tensor imaging

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Acknowledgments

Pieter Van Dyck and Christiaan Heusdens are supported by the research foundation Flanders (FWO Vlaanderen), Belgium (grants 1831217N and T001017N, respectively).

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium

    Pieter Van Dyck & Damien Desbuquoit

  2. Icometrix, Kolonel Begaultlaan 1b, 3012, Leuven, Belgium

    Thibo Billiet

  3. Monica Orthopedic Research (MoRe) Foundation, Monica Hospital, Stevenslei 20, 2100, Deurne, Belgium

    Peter Verdonk

  4. Department of Orthopedics, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium

    Christiaan H. Heusdens

  5. Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium

    Ella Roelant

  6. Imec-Vision Lab, Department of Physics, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium

    Jan Sijbers

  7. Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Martijn Froeling

Authors
  1. Pieter Van Dyck
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Corresponding author

Correspondence to Pieter Van Dyck.

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Guarantor

The scientific guarantor of this publication is Pieter Van Dyck.

Conflict of interest

Thibo Billiet is an employee of Icometrix, Leuven, Belgium. Other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Ella Roelant, biostatistician at the Antwerp University Hospital, provided statistical analyses for this manuscript.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The 7 healthy controls were also included in a previous study that analyzed DTI changes of the ACL following primary repair. This paper is published in the Journal of Orthopaedic Research (https://doi.org/10.1002/jor.24684).

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Van Dyck, P., Billiet, T., Desbuquoit, D. et al. Diffusion tensor imaging of the anterior cruciate ligament graft following reconstruction: a longitudinal study. Eur Radiol 30, 6673–6684 (2020). https://doi.org/10.1007/s00330-020-07051-w

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