Skip to main content
Top
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2017

01-10-2017 | Knee

MRI-based ACL graft maturity does not predict clinical and functional outcomes during the first year after ACL reconstruction

Authors: Hong Li, Jiwu Chen, Hongyun Li, Ziying Wu, Shiyi Chen

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2017

Login to get access

Abstract

Purpose

To determine whether magnetic resonance image (MRI)-based graft maturity predicts clinical and functional scores during the first year after ACL reconstruction.

Methods

Patients with unilateral ACL reconstruction were prospectively invited to participate in this study, and they were examined using a 3.0-T MRI scan at 3, 6, and 12 months after the operation. Clinical examinations were performed on the same day, including subjective functional examinations, physical examinations and the KT-1000 test. MRI measurements were focused on the graft signal intensity of the ACL graft using the signal/noise quotient value from a region of interest analysis.

Results

Finally, a total of 38 participants with ACL reconstruction were recruited for this study, including 21 with autograft tendons and 17 with allograft tendons. Generally, the signal/noise quotient values of the ACL grafts increased from 3 to 6 months and then decreased from 6 to 12 months. There was no significant association between graft signal/noise quotient value and IKDC, Lysholm, or Tegner scores at each time point. Graft signal/noise quotient value had a significant positive association with ATTD for the cohort (p = 0.002) and for the autograft group (p = 0.004) at 3 months. However, there was no significant association between graft signal/noise quotient value and ATTD at 6 or 12 months, respectively.

Conclusion

The MRI-based graft maturity does not have the ability to predict clinical and functional outcomes in patients at the first-year follow-up. Graft maturity should not be used as an objective test to determine the appropriate time to return to sports during the first year after ACL reconstruction. The results from this study will allow clinicians to determine graft-specific health to determine whether the graft is healed enough to return to sports during the first postoperative year.

Level of evidence

III.
Literature
1.
go back to reference Anderson K, Seneviratne AM, Izawa K, Atkinson BL, Potter HG, Rodeo SA (2001) Augmentation of tendon healing in an intraarticular bone tunnel with use of a bone growth factor. Am J Sports Med 29:689–698CrossRefPubMed Anderson K, Seneviratne AM, Izawa K, Atkinson BL, Potter HG, Rodeo SA (2001) Augmentation of tendon healing in an intraarticular bone tunnel with use of a bone growth factor. Am J Sports Med 29:689–698CrossRefPubMed
2.
go back to reference Ardern CL, Taylor NF, Feller JA, Webster KE (2014) Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 48:1543–1552CrossRefPubMed Ardern CL, Taylor NF, Feller JA, Webster KE (2014) Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 48:1543–1552CrossRefPubMed
3.
go back to reference Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE (2015) Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: a prospective follow-up of physical function and psychological factors in 122 athletes. Am J Sports Med 43:848–856CrossRefPubMed Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE (2015) Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: a prospective follow-up of physical function and psychological factors in 122 athletes. Am J Sports Med 43:848–856CrossRefPubMed
4.
go back to reference Barber-Westin SD, Noyes FR (2011) Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy 27:1697–1705CrossRefPubMed Barber-Westin SD, Noyes FR (2011) Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy 27:1697–1705CrossRefPubMed
5.
go back to reference Barber-Westin SD, Noyes FR (2011) Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sportsmed 39:100–110CrossRefPubMed Barber-Westin SD, Noyes FR (2011) Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sportsmed 39:100–110CrossRefPubMed
6.
go back to reference Bedi A, Altchek DW (2009) The “footprint” anterior cruciate ligament technique: an anatomic approach to anterior cruciate ligament reconstruction. Arthroscopy 25:1128–1138CrossRefPubMed Bedi A, Altchek DW (2009) The “footprint” anterior cruciate ligament technique: an anatomic approach to anterior cruciate ligament reconstruction. Arthroscopy 25:1128–1138CrossRefPubMed
7.
go back to reference Biercevicz AM, Akelman MR, Fadale PD, Hulstyn MJ, Shalvoy RM, Badger GJ, Tung GA, Oksendahl HL, Fleming BC (2015) MRI volume and signal intensity of ACL graft predict clinical, functional, and patient-oriented outcome measures after ACL reconstruction. Am J Sports Med 43:693–699CrossRefPubMed Biercevicz AM, Akelman MR, Fadale PD, Hulstyn MJ, Shalvoy RM, Badger GJ, Tung GA, Oksendahl HL, Fleming BC (2015) MRI volume and signal intensity of ACL graft predict clinical, functional, and patient-oriented outcome measures after ACL reconstruction. Am J Sports Med 43:693–699CrossRefPubMed
8.
go back to reference Biercevicz AM, Miranda DL, Machan JT, Murray MM, Fleming BC (2013) In Situ, noninvasive, T2*-weighted MRI-derived parameters predict ex vivo structural properties of an anterior cruciate ligament reconstruction or bioenhanced primary repair in a porcine model. Am J Sports Med 41:560–566CrossRefPubMedPubMedCentral Biercevicz AM, Miranda DL, Machan JT, Murray MM, Fleming BC (2013) In Situ, noninvasive, T2*-weighted MRI-derived parameters predict ex vivo structural properties of an anterior cruciate ligament reconstruction or bioenhanced primary repair in a porcine model. Am J Sports Med 41:560–566CrossRefPubMedPubMedCentral
9.
go back to reference Bizzini M, Hancock D, Impellizzeri F (2012) Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: soccer. J Orthop Sports Phys Ther 42:304–312CrossRefPubMed Bizzini M, Hancock D, Impellizzeri F (2012) Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: soccer. J Orthop Sports Phys Ther 42:304–312CrossRefPubMed
10.
go back to reference Bourke HE, Salmon LJ, Waller A, Patterson V, Pinczewski LA (2012) Survival of the anterior cruciate ligament graft and the contralateral ACL at a minimum of 15 years. Am J Sports Med 40:1985–1992CrossRefPubMed Bourke HE, Salmon LJ, Waller A, Patterson V, Pinczewski LA (2012) Survival of the anterior cruciate ligament graft and the contralateral ACL at a minimum of 15 years. Am J Sports Med 40:1985–1992CrossRefPubMed
11.
go back to reference Della Villa S, Boldrini L, Ricci M, Danelon F, Snyder-Mackler L, Nanni G, Roi GS (2012) Clinical outcomes and return-to-sports participation of 50 soccer players after anterior cruciate ligament reconstruction through a sport-specific rehabilitation protocol. Sports Health 4:17–24CrossRefPubMedPubMedCentral Della Villa S, Boldrini L, Ricci M, Danelon F, Snyder-Mackler L, Nanni G, Roi GS (2012) Clinical outcomes and return-to-sports participation of 50 soccer players after anterior cruciate ligament reconstruction through a sport-specific rehabilitation protocol. Sports Health 4:17–24CrossRefPubMedPubMedCentral
12.
go back to reference Fleming BC, Vajapeyam S, Connolly SA, Magarian EM, Murray MM (2011) The use of magnetic resonance imaging to predict ACL graft structural properties. J Biomech 44:2843–2846CrossRefPubMedPubMedCentral Fleming BC, Vajapeyam S, Connolly SA, Magarian EM, Murray MM (2011) The use of magnetic resonance imaging to predict ACL graft structural properties. J Biomech 44:2843–2846CrossRefPubMedPubMedCentral
13.
go back to reference Gohil S, Annear PO, Breidahl W (2007) Anterior cruciate ligament reconstruction using autologous double hamstrings: a comparison of standard versus minimal debridement techniques using MRI to assess revascularisation. A randomised prospective study with a one-year follow-up. J Bone Joint Surg Br 89:1165–1171CrossRefPubMed Gohil S, Annear PO, Breidahl W (2007) Anterior cruciate ligament reconstruction using autologous double hamstrings: a comparison of standard versus minimal debridement techniques using MRI to assess revascularisation. A randomised prospective study with a one-year follow-up. J Bone Joint Surg Br 89:1165–1171CrossRefPubMed
14.
go back to reference Grindem H, Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA (2012) A pair-matched comparison of return to pivoting sports at 1 year in anterior cruciate ligament-injured patients after a nonoperative versus an operative treatment course. Am J Sports Med 40:2509–2516CrossRefPubMedPubMedCentral Grindem H, Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA (2012) A pair-matched comparison of return to pivoting sports at 1 year in anterior cruciate ligament-injured patients after a nonoperative versus an operative treatment course. Am J Sports Med 40:2509–2516CrossRefPubMedPubMedCentral
15.
go back to reference Hewett TE, Di Stasi SL, Myer GD (2013) Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med 41:216–224CrossRefPubMed Hewett TE, Di Stasi SL, Myer GD (2013) Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med 41:216–224CrossRefPubMed
16.
go back to reference Howell SM, Knox KE, Farley TE, Taylor MA (1995) Revascularization of a human anterior cruciate ligament graft during the first two years of implantation. Am J Sports Med 23:42–49CrossRefPubMed Howell SM, Knox KE, Farley TE, Taylor MA (1995) Revascularization of a human anterior cruciate ligament graft during the first two years of implantation. Am J Sports Med 23:42–49CrossRefPubMed
17.
go back to reference Hui C, Salmon LJ, Kok A, Maeno S, Linklater J, Pinczewski LA (2011) Fifteen-year outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft for “isolated” anterior cruciate ligament tear. Am J Sports Med 39:89–98CrossRefPubMed Hui C, Salmon LJ, Kok A, Maeno S, Linklater J, Pinczewski LA (2011) Fifteen-year outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft for “isolated” anterior cruciate ligament tear. Am J Sports Med 39:89–98CrossRefPubMed
18.
go back to reference Janssen RP, Scheffler SU (2014) Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 22:2102–2108CrossRefPubMed Janssen RP, Scheffler SU (2014) Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 22:2102–2108CrossRefPubMed
19.
go back to reference Li H, Chen S, Tao H (2014) Correlation analysis of potential factors influencing graft maturity after anterior cruciate ligament reconstruction. Orthop J Sports Med 2:2325967114553552CrossRefPubMedPubMedCentral Li H, Chen S, Tao H (2014) Correlation analysis of potential factors influencing graft maturity after anterior cruciate ligament reconstruction. Orthop J Sports Med 2:2325967114553552CrossRefPubMedPubMedCentral
20.
go back to reference Li H, Tao H, Cho S, Chen S, Yao Z (2012) Difference in graft maturity of the reconstructed anterior cruciate ligament 2 years postoperatively: a comparison between autografts and allografts in young men using clinical and 3.0-T magnetic resonance imaging evaluation. Am J Sports Med 40:1519–1526CrossRefPubMed Li H, Tao H, Cho S, Chen S, Yao Z (2012) Difference in graft maturity of the reconstructed anterior cruciate ligament 2 years postoperatively: a comparison between autografts and allografts in young men using clinical and 3.0-T magnetic resonance imaging evaluation. Am J Sports Med 40:1519–1526CrossRefPubMed
21.
go back to reference Ma Y, Murawski CD, Rahnemai-Azar AA, Maldjian C, Lynch AD, Fu FH (2015) Graft maturity of the reconstructed anterior cruciate ligament 6 months postoperatively: a magnetic resonance imaging evaluation of quadriceps tendon with bone block and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 23:661–668CrossRefPubMed Ma Y, Murawski CD, Rahnemai-Azar AA, Maldjian C, Lynch AD, Fu FH (2015) Graft maturity of the reconstructed anterior cruciate ligament 6 months postoperatively: a magnetic resonance imaging evaluation of quadriceps tendon with bone block and hamstring tendon autografts. Knee Surg Sports Traumatol Arthrosc 23:661–668CrossRefPubMed
22.
go back to reference Muramatsu K, Hachiya Y, Izawa H (2008) Serial evaluation of human anterior cruciate ligament grafts by contrast-enhanced magnetic resonance imaging: comparison of allografts and autografts. Arthroscopy 24:1038–1044CrossRefPubMed Muramatsu K, Hachiya Y, Izawa H (2008) Serial evaluation of human anterior cruciate ligament grafts by contrast-enhanced magnetic resonance imaging: comparison of allografts and autografts. Arthroscopy 24:1038–1044CrossRefPubMed
23.
go back to reference Myer GD, Martin L Jr, Ford KR, Paterno MV, Schmitt LC, Heidt RS Jr, Colosimo A, Hewett TE (2012) No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction: evidence for objective return-to-sport criteria. Am J Sports Med 40:2256–2263CrossRefPubMedPubMedCentral Myer GD, Martin L Jr, Ford KR, Paterno MV, Schmitt LC, Heidt RS Jr, Colosimo A, Hewett TE (2012) No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction: evidence for objective return-to-sport criteria. Am J Sports Med 40:2256–2263CrossRefPubMedPubMedCentral
24.
go back to reference Narducci E, Waltz A, Gorski K, Leppla L, Donaldson M (2011) The clinical utility of functional performance tests within one-year post-acl reconstruction: a systematic review. Int J Sports Phys Ther 6:333–342PubMedPubMedCentral Narducci E, Waltz A, Gorski K, Leppla L, Donaldson M (2011) The clinical utility of functional performance tests within one-year post-acl reconstruction: a systematic review. Int J Sports Phys Ther 6:333–342PubMedPubMedCentral
25.
go back to reference Ntoulia A, Papadopoulou F, Ristanis S, Argyropoulou M, Georgoulis AD (2011) Revascularization process of the bone–patellar tendon–bone autograft evaluated by contrast-enhanced magnetic resonance imaging 6 and 12 months after anterior cruciate ligament reconstruction. Am J Sports Med 39:1478–1486CrossRefPubMed Ntoulia A, Papadopoulou F, Ristanis S, Argyropoulou M, Georgoulis AD (2011) Revascularization process of the bone–patellar tendon–bone autograft evaluated by contrast-enhanced magnetic resonance imaging 6 and 12 months after anterior cruciate ligament reconstruction. Am J Sports Med 39:1478–1486CrossRefPubMed
26.
go back to reference Ng GY, Oakes BW, Deacon OW, McLean ID, Eyre DR (1996) Long-term study of the biochemistry and biomechanics of anterior cruciate ligament-patellar tendon autografts in goats. J Orthop Res 14:851–856CrossRefPubMed Ng GY, Oakes BW, Deacon OW, McLean ID, Eyre DR (1996) Long-term study of the biochemistry and biomechanics of anterior cruciate ligament-patellar tendon autografts in goats. J Orthop Res 14:851–856CrossRefPubMed
27.
go back to reference Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE (2010) Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med 38:1968–1978CrossRefPubMedPubMedCentral Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE (2010) Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med 38:1968–1978CrossRefPubMedPubMedCentral
28.
go back to reference Suomalainen P, Moisala AS, Paakkala A, Kannus P, Jarvela T (2011) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: randomized clinical and magnetic resonance imaging study with 2-year follow-up. Am J Sports Med 39:1615–1622CrossRefPubMed Suomalainen P, Moisala AS, Paakkala A, Kannus P, Jarvela T (2011) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: randomized clinical and magnetic resonance imaging study with 2-year follow-up. Am J Sports Med 39:1615–1622CrossRefPubMed
29.
go back to reference van Eck CF, Schkrohowsky JG, Working ZM, Irrgang JJ, Fu FH (2012) Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft. Am J Sports Med 40:800–807CrossRefPubMed van Eck CF, Schkrohowsky JG, Working ZM, Irrgang JJ, Fu FH (2012) Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft. Am J Sports Med 40:800–807CrossRefPubMed
30.
go back to reference van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH (2010) “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26:S2–S12CrossRefPubMed van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH (2010) “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26:S2–S12CrossRefPubMed
31.
go back to reference White LM, Kramer J, Recht MP (2005) MR imaging evaluation of the postoperative knee: ligaments, menisci, and articular cartilage. Skelet Radiol 34:431–452CrossRef White LM, Kramer J, Recht MP (2005) MR imaging evaluation of the postoperative knee: ligaments, menisci, and articular cartilage. Skelet Radiol 34:431–452CrossRef
32.
go back to reference Yabroudi MA, Irrgang JJ (2013) Rehabilitation and return to play after anatomic anterior cruciate ligament reconstruction. Clin Sports Med 32:165–175CrossRefPubMed Yabroudi MA, Irrgang JJ (2013) Rehabilitation and return to play after anatomic anterior cruciate ligament reconstruction. Clin Sports Med 32:165–175CrossRefPubMed
Metadata
Title
MRI-based ACL graft maturity does not predict clinical and functional outcomes during the first year after ACL reconstruction
Authors
Hong Li
Jiwu Chen
Hongyun Li
Ziying Wu
Shiyi Chen
Publication date
01-10-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4252-5

Other articles of this Issue 10/2017

Knee Surgery, Sports Traumatology, Arthroscopy 10/2017 Go to the issue