Imaging of Anterior Cruciate Ligament Repair and Its Complications

Meyers, Arthur B.; Haims, Andrew; Menn, Kirsten; Moukaddam, Hicham

doi:10.2214/ajr.09.3200

Cited by 67 publications

(90 citation statements)

References 29 publications

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“…However, there are drawbacks related to ACL reconstruction surgeries. [5][6][7] Recent studies have also shown that 70%-80% of the patients develop radiographic signs of osteoarthritis in the ACL reconstructed knee after 10 to 15 years. 8,9 Therefore, clinicians and researchers are aiming to improve the current treatment for ACL ruptures.…”

Section: Introductionmentioning

confidence: 99%

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Nguyen

Geel

Schulze

et al. 2013

Tissue Engineering Part A

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Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining conditions can be improved by introducing a new suturing technique and by using small intestinal submucosa (SIS) as a bioscaffold. It is hypothesized that the suturing technique keep the torn ends together and that SIS enhance and promote the healing of the ACL. The goat was used as the study model. In the Suture group, the left ACL was transected and suture repaired with a new locking suture repair technique (n = 5) allowing approximation and fixation under tension. The Suture-SIS group underwent the same procedure with the addition of SIS (n = 5). The right ACL served as control. After 12 weeks of healing, anterior-posterior translation and in situ force of the healing ACL were measured, followed by the measurement of the cross-sectional area and structural stiffness. Routine histology was performed on tissue samples. Gross morphology showed that the healing ACL was continuous with collagenous tissue in both groups. The cross-sectional area of the Suture and the Suture-SIS group was 35% and 50% of the intact control, respectively. The anterior-posterior translations at different flexion angles were statistically not different between the Suture group and the Suture-SIS group. Only the in situ force at 30°in the Suture-SIS group was higher than in the Suture group. Tensile tests showed that the stiffness for the Suture group was not different from the Suture-SIS group (31.1 -8.1 N/mm vs. 41.9 -18.0 N/mm [p > 0.05]). Histology showed longitudinally aligned collagen fibers from origo to insertion. More fibroblasts were present in the healing tissue than in the control intact tissue. The study demonstrated the proof of concept of ACL repair in a goat model with a new suture technique and SIS. The mechanical outcome is not worse than previously reported for ACL reconstruction. In conclusion, the approach of using a new suture technique, with or without a bioscaffold to heal the ACL is promising.

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Section: Introductionmentioning

confidence: 99%

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Nguyen

Geel

Schulze

et al. 2013

Tissue Engineering Part A

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“…articular cartilage and menisci. The most commonly used methods are bone-patellar tendon-bone and hamstring autografts (2,5). When an autogenous bone-patellar tendonbone graft is used, the graft material and bone plugs are anatomically stabilized within the tunnels opened in the femur and tibia in accordance with the normal course of the ligament.…”

Section: Figure 1: (A B)mentioning

confidence: 99%

“…tears (5,8). Interstitial graft tears appear as focal areas of increased signal intensity covering a portion of the graft with intact fi bers still present on T2-weighted or PD-weighted MRI.…”

Section: A B Cmentioning

confidence: 99%

“…Interstitial graft tears appear as focal areas of increased signal intensity covering a portion of the graft with intact fi bers still present on T2-weighted or PD-weighted MRI. The differential diagnosis for interstitial graft tear includes the normal revascularization, synovialization and ligamentization phase in clinically stable immature ACL grafts that commonly show increased signal on T2-weighted and PD-weighted sequences for 3-18 months after ACL reconstruction surgery (5,9). During the fi rst three months after ACL reconstruction, graft constructs are typically uniformly low in signal intensity on T1-weighted, T2-weighted and PD-weighted MR images.…”

Section: A B Cmentioning

confidence: 99%

“…During the fi rst three months after ACL reconstruction, graft constructs are typically uniformly low in signal intensity on T1-weighted, T2-weighted and PD-weighted MR images. Thereafter, progressive vascularization, synovialization and ligamentization start in the graft (5,9). However, by two years after ACL reconstruction, normal graft tendon should resume a uniform normal low-signal-intensity MRI appearance.…”

Section: A B Cmentioning

confidence: 99%

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Imaging of Anterior Cruciate Ligament Graft Reconstruction

Durmaz¹,

Göya²,

Hamidi³

et al. 2018

Akd Med J

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Objective: The purpose of this study was to describe the postoperative X-Ray and magnetic resonance imaging(MRI) appearance of normal anterior cruciate ligament (ACL) graft reconstructions and to demonstrate most common potential complications. Material and Methods: Fifty-two patients with ACL reconstruction were included in the study. The X-Ray and MRI scans were reviewed retrospectively for the assessment of integrity of the reconstructed ligament and the presence of related complications. Results: Pathologic fi ndings were observed in 18 of 52 ACL reconstruction operations; Four total ACL graft ruptures and one partial rupture, two loosening grafts, 10 anteriorly localized tibial tunnels, eight roof impingements, two side wall impingements, four cystic tunnel dilatations, one patellar fracture, two iliotibial band friction syndromes because of hardware related complications, and four arthrofi brosis cases were observed. Conclusion: MRI is an effective imaging technique for evaluating the position of ACL grafts, tunnels and fi xation materials and for investigating the cause of pain and loss of function. Key Words: Anterior Cruciate Ligament, Graft reconstruction, MR imaging ÖZ Amaç: Ön çapraz bağ (ÖÇB) greft rekonstrüksiyonunun postoperatif direkt grafi , manyetik rezonans görüntüleme(MRG) normal bulgularını tanımlamak, operasyon sonrası gelişebilecek potansiyel komplikasyonlarının MRG bulgularını sunmaktır. Gereç ve Yöntemler: Çalışmaya ÖÇB rekonstrüksiyon cerrahisi geçirmiş 52 hasta alındı. Hastaların direkt grafi , manyetik rezonans görüntüleri ÖÇB greft bütünlüğü ve eşlik edebilecek komplikasyonlar açısından retrospektif olarak değerlendirildi. Bulgular: Çalışmaya alınan 52 hastanın 18'inde postoperatif patolojik bulgular saptandı. Dört hastada total greft rüptürü, bir hastada parsiyel greft rüptürü, iki hastada gevşek greft, 10 hastada anterior yerleşimli tibial tünel, sekiz hastada tepe impigement, iki hastada yan duvar impigement, dört hastada tünelde kistik genişleme, bir hastada patellar fraktür, iki hastada operasyon materyaline bağlı iliotibial band sürtünme sendromu ve dört hastada artrofi brozis saptandı. Sonuç: MRG, ÖÇB greftinin, tünellerin ve fi ksasyon materyallerinin pozisyonunu değerlendirmede, operasyon sonrası ağrı ve fonksiyon kaybının nedenini araştırmada kullanılabilen etkili bir görüntüle-me yöntemidir.

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