Comparison of sagittal obliquity of the reconstructed anterior cruciate ligament with native anterior cruciate ligament using magnetic resonance imaging

Purpose: This study was conducted to compare the obliquity of asymptomatic anterior cruciate ligament (ACL) grafts with normal controls using sagittal magnetic resonance imaging (MRI). Type of Study: Case control study. Methods: Sagittal MRIs from 30 patients with a reconstructed ACL graft and from 30 individuals with an intact ACL were reviewed. Reconstructed patients were operated on with a 2-incision technique using a patellar tendon autograft. These selected patients had a normal or nearly normal IKDC score with a 3 mm or less anterior posterior translation on KT-1000 arthrometer testing compared with the intact knee. MRI showed a continuous and homogeneous graft without evidence of roof impingement. Obliquity of the grafted ACL was determined on each lateral MRI by measuring the intersection of the graft line with the tibial plateau plane. These figures were compared with data similarly obtained from 30 individuals with a stable knee and an intact ACL determined by history and physical examination. Results: Graft obliquity in reconstructed patients averaged 67° with a range between 55° and 81°. In normal controls, intact ACL obliquity averaged 51° with a range between 45° and 55°. The difference between the two groups was statistically significant (P <.0001). Conclusions: MRIs of patients with an appropriate tibial tunnel placement in order to avoid notch impingement showed a continuous and homogeneous graft similar to the native ACL, but with a more vertical graft that does not recreate the normal sagittal obliquity. However, according to arthrometer testing, these more vertical grafts can control anterior posterior knee displacement.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp 257–261