MRI analysis of single-, double-, and triple-bundle anterior cruciate ligament grafts |
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Authors: | Yoshinari Tanaka Yasukazu Yonetani Yoshiki Shiozaki Takashi Kanamoto Keisuke Kita Hiroshi Amano Masashi Kusano Masashi Hirakawa Shuji Horibe |
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Affiliation: | 1. Department of Sports Orthopedics, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 583-8555, Japan 2. Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan 3. Department of Orthopedic Surgery, Seifu Hospital, Sakai, Japan 4. Department of Orthopedic Surgery, Oita University, Oita, Japan 5. Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
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Abstract: | Purpose The purpose of the study was to evaluate the entire course of ACL grafts on coronal oblique MR images, focusing on differences in graft morphology and graft-to-tunnel healing among single-bundle (SB), double-bundle (DB), and triple-bundle (TB) reconstructions. Methods Eighty-three patients underwent anatomical ACL reconstruction using the semitendinosus tendon. SB reconstruction was performed on 20 patients, DB on 29 patients, and TB on 34 patients. The anteromedial-bundle (AMB) and posterolateral-bundle (PLB) images were extracted from coronal oblique images of grafts at 6 months to visualize their entire course. Signal intensity of grafts was measured independently in three regions: (1) intra-femoral tunnel region, (2) intra-articular region, and (3) intra-tibial tunnel region, followed by calculation of the signal-to-noise quotient (SNQ). To evaluate graft-to-tunnel healing, T2-weighted images were examined for the presence of a high signal-intensity lesion between the graft and bone tunnel around the tunnel aperture. Results AMB images showed that SB graft was thick throughout the entire course, while DB graft was thinner than SB graft. TB graft showed a fan shape approaching the tibial tunnels. The SNQ in the femoral tunnel of SB graft was significantly lower than in the DB and TB grafts. High signal-intensity lesions were frequently observed around the femoral tunnel aperture in PLB images of DB and TB grafts compared to SB grafts. Conclusion Gross morphology of TB grafts resembled that of the natural ACL. However, the graft-to-tunnel healing around the femoral tunnel seemed to be insufficient in PLB images of DB and TB compared to SB grafts. Level of evidence III. |
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