Effect of Modified Lemaire Anterolateral Extra-articular Tenodesis on the Magnetic Resonance Imaging Maturity Signal of Anterior Cruciate Ligament Hamstring Graft

2021 ◽  
pp. 036354652110188
Author(s):  
Gonzalo Rojas ◽  
Simone Perelli ◽  
Maximiliano Ibanez ◽  
Mario Formagnana ◽  
Inmaculada Ormazabal ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Resonance Imaging ◽  
Acl Graft ◽  
Significant Difference ◽  
The Mean ◽  
Anterior Cruciate

Background: Lateral extra-articular tenodesis (LET) is one of the most widely used procedures to restore anterolateral stability. Clinical outcomes after the addition of LET to anterior cruciate ligament (ACL) reconstruction (ACLR) have been widely investigated; however, the potential influence of LET on the ACL ligamentization process has not been examined. Purpose/Hypothesis: The purpose was to use 10-month postoperative magnetic resonance imaging (MRI) scans to determine whether the maturity of grafts after hamstring autograft ACLR was affected by concomitant LET. The hypothesis was that when modified Lemaire lateral extra-articular tenodesis (MLLET) was performed, the MRI parameters of ACL graft maturity would be modified. Study Design: Cohort study; Level of evidence, 3. Methods: The study included patients treated between December 2017 and December 2018 who had undergone anatomic 3-strand hamstring tendon autograft ACLR, with or without concomitant MLLET, and had undergone MRI 10 months postoperatively. Thus, the study included 30 patients who had isolated ACLR and 22 patients who had ACLR plus MLLET. The 2 groups were comparable based on all criteria analyzed. To evaluate graft maturity, the signal-to-noise quotient (SNQ) was measured in 3 regions of interest of the proximal, midsubstance, and distal ACL graft. Lower SNQ ratios indicate less water content and, theoretically, better maturity and healing of the graft. Results: The mean ± SD for SNQ was 4.62 ± 4.29 (range, 3.12-6.19) in the isolated ACLR group and 7.59 ± 4.68 (range, 4.38-8.04) in the ACLR plus MLLET group ( P = .012). Upon comparing the mean values of the 3 portions between the 2 groups, we found a significant difference between the 2 groups for the proximal and middle portions ( P = .007 and P = .049, respectively) but no difference in the distal portion ( P = .369). Conclusion: At the 10-month follow-up, hamstring tendon autografts for anatomic ACLR with MLLET did not show the same MRI signal intensity compared with isolated hamstring anatomic ACLR.

scholarly journals Reliability of Magnetic Resonance Imaging Prediction of Anterior Cruciate Ligament Autograft Size and Comparison of Radiologist and Orthopaedic Surgeon Predictions

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988959 ◽  
Author(s):  
Andrew Hanna ◽  
Katharine Hollnagel ◽  
Kelley Whitmer ◽  
Christopher John ◽  
Brent Johnson ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Sports Medicine ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Resonance Imaging ◽  
Graft Size ◽  
Orthopaedic Surgeons ◽  
Anterior Cruciate

Background: In anterior cruciate ligament (ACL) reconstruction, hamstring tendon autografts <8 mm have been associated with increased failure rates. There has been no established modality by which orthopaedic surgeons can preoperatively predict graft sizes. Purpose/Hypothesis: The purposes of this study were to (1) determine whether routine magnetic resonance imaging (MRI) measurement of hamstring tendon cross-sectional area (CSA) can reliably be used by sports medicine fellowship–trained orthopaedic surgeons to predict graft size and (2) determine whether radiologists and sports medicine surgeons are able to discriminate grafts below a predetermined cutoff value. We hypothesized that radiologists will find a correlation between MRI measurement and intraoperative graft size. Similarly, orthopaedic surgeons will be able to correctly estimate the graft size based on MRI measurement. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Included in this study were 30 consecutive patients (15 women and 15 men) (mean age, 23 years [range, 13-43 years]) for whom MRI-determined hamstring tendon CSA and graft size measurements could be compared. Patients were included if they had a preoperative MRI demonstrating acute ACL rupture and were scheduled with 1 of 3 surgeons for a reconstruction performed using the ST and GR tendons. Operative data were collected over 1 year. Sectra imaging software was used to measure the CSA of the semitendinosus (ST) and gracilis (GR) tendons on the preoperative MRIs. Control measurements were performed intraoperatively using a graft sizing block with 0.5-mm increments. Simple linear regression analysis was used to evaluate the ability of MRI measurements to predict autograft size. Logistic regression was used to determine the minimum CSA for a graft of 8 mm. The intraclass correlation coefficient (ICC) was used to evaluate interrater reliability. Results: MRI CSA measurement of the average STGR (ST CSA added to the GR CSA) was a significant predictor of graft size (adjusted R 2 = 0.186; P < .001). The 3 measurements with the strongest correlations with graft size were the ST at the medial femoral condyle (MFC), the STGR at the MFC, and the average STGR. The minimum CSA for the average STGR on MRI to achieve a graft size of 8 mm was 17.168 mm2 ( P < .001). The area under the receiver operating characteristic curve was 0.765. The overall ICC was 0.977. Conclusion: Routine preoperative MRI can be used by both radiologists and orthopaedic surgeons to predict the expected ACL autograft size and identify those below a cutoff of 8 mm. This will help in preoperative planning and graft selection.

scholarly journals Assessment of Anterior Cruciate Ligament Graft Maturity With Conventional Magnetic Resonance Imaging: A Systematic Literature Review

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711984901 ◽  
Author(s):  
Pieter Van Dyck ◽  
Katja Zazulia ◽  
Céline Smekens ◽  
Christiaan H.W. Heusdens ◽  
Thomas Janssens ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Resonance Imaging ◽  
Acl Graft ◽  
Conventional Mri ◽  
Anterior Cruciate

Background: Magnetic resonance imaging (MRI) signal intensity (SI) measurements are being used increasingly in both clinical and research studies to assess the maturity of anterior cruciate ligament (ACL) grafts in humans. However, SI in conventional MRI with weighted images is a nonquantitative measure dependent on hardware and software. Purpose: To conduct a systematic review of studies that have used MRI SI as a proxy for ACL graft maturity and to identify potential confounding factors in assessing the ACL graft in conventional MRI studies. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted by searching the MEDLINE/PubMed, Scopus, and Cochrane Library electronic databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies that examined the healing of the intra-articular portion of the ACL graft by assessing SI on MRIs. Results: A total of 34 studies were selected for inclusion in this systematic review. The MRI acquisition techniques and methods to evaluate the ACL graft SI differed greatly across the studies. No agreement was found regarding the time frames of SI changes in MRI reflecting normal healing of the ACL tendon graft, and the graft SI and clinical outcomes after ACL reconstruction were found to be poorly correlated. Conclusion: The MRI acquisition and evaluation methods used to assess ACL grafts are very heterogeneous, impeding comparisons of SI between successive scans and between independent studies. Therefore, quantitative MRI-based biomarkers of ACL graft healing are greatly needed to guide the appropriate time of returning to sports after ACL reconstruction.

The Role of Magnetic Resonance Imaging for Diagnosing Soft Tissue Lesions Associated with Anterior Cruciate Ligament Injuries

2018 ◽  
Vol 69 (9) ◽  
pp. 2498-2500
Author(s):  
Bogdan Sendrea ◽  
Antoine Edu ◽  
George Viscopoleanu
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Soft Tissue ◽  
Traumatic Event ◽  
Cruciate Ligament ◽  
Soft Tissue Injuries ◽  
Resonance Imaging ◽  
Soft Tissue Lesions ◽  
Anterior Cruciate

Magnetic resonance imaging has become the gold standard for soft tissue lesions evaluation especially after a traumatic event where there is need for diagnostic confirmation. The objective of the current paper was to evaluate the ability of magnetic resonance imaging in diagnosing soft tissue lesions in patients who underwent anterior cruciate ligament reconstruction compared with arthroscopic findings. Through the ability to diagnose soft tissue injuries, particularly meniscal lesions, magnetic resonance imaging should be considered as fundamental in guiding therapeutic management in patients with anterior cruciate ligament lesions.

Clinical Implications of Bone Bruise Patterns Accompanying Anterior Cruciate Ligament Tears

2021 ◽  
pp. 194173812110295
Author(s):  
Patrick Ward ◽  
Peter Chang ◽  
Logan Radtke ◽  
Robert H. Brophy
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Functional Outcomes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Bone Bruise ◽  
Resonance Imaging ◽  
Bone Bruises ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears are common injuries; they are often associated with concomitant injuries to other structures in the knee, including bone bruises. While there is limited evidence that bone bruises are associated with slightly worse clinical outcomes, the implications of bone bruises for the articular cartilage and the risk of developing osteoarthritis (OA) in the knee are less clear. Recent studies suggest that the bone bruise pattern may be helpful in predicting the presence of meniscal ramp lesions. Evidence Acquisition: A literature review was performed in EMBASE using the keyword search phrase (acl OR (anterior AND cruciate AND ligament)) AND ((bone AND bruise) OR (bone AND contusion) OR (bone AND marrow AND edema) OR (bone AND marrow AND lesion) OR (subchondral AND edema)). Study Design: Clinical review. Level of Evidence: Level 4. Results: The literature search returned 93 articles of which 25 were ultimately included in this review. Most studies identified a high prevalence of bone bruises in the setting of acute ACL injury. Individual studies have found relationships between bone bruise volume and functional outcomes; however, these results were not supported by systematic review. Similarly, the literature has contradictory findings on the relationship between bone bruises and the progression of OA after ACL reconstruction. Investigations into concomitant injury found anterolateral ligament and meniscal ramp lesions to be associated with bone bruise presence on magnetic resonance imaging. Conclusion: Despite the ample literature identifying the prevalence of bone bruises in association with ACL injury, there is little evidence to correlate bone bruises to functional outcomes or progression of OA. Bone bruises may best be used as a marker for concomitant injury such as medial meniscal ramp lesions that are not always well visualized on magnetic resonance imaging. Further research is required to establish the longitudinal effects of bone bruises on ACL tear recovery. Strength of Recommendation Taxonomy: 2.

scholarly journals Anterior cruciate ligament ganglion: case report

2002 ◽  
Vol 120 (6) ◽  
pp. 195-197 ◽  
Author(s):  
André Pedrinelli ◽  
Fábio Bonini Castellana ◽  
Ricardo Bragança de Vasconcellos Fontes ◽  
Rafael Ferreira Coelho ◽  
Luiz Álvaro de Menezes F°.
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Case Report ◽  
Magnetic Resonance ◽  
Cruciate Ligament ◽  
Clinical Signs ◽  
Left Knee ◽  
Pathological Examination ◽  
Resonance Imaging ◽  
Anterior Cruciate

CONTEXT: A ganglion is a cystic formation close to joints or tendinous sheaths, frequently found in the wrist, foot or knee. Intra-articular ganglia of the knee are rare, and most of them are located in the anterior cruciate ligament. The clinical picture for these ganglia comprises pain and movement restrictions in the knee, causing significant impairment to the patient. Symptoms are non-specific, and anterior cruciate ligament ganglia are usually diagnosed through magnetic resonance imaging or arthroscopy. Not all ganglia diagnosed through magnetic resonance imaging need to undergo surgical treatment: only those that cause clinical signs and symptoms do. Surgical results are considered good or excellent in the vast majority of cases. CASE REPORT: A 29-year-old male presented with pain in the left knee during a marathon race. Physical examination revealed limitation in the maximum range of knee extension and pain in the posterior aspect of the left knee. Radiographs of the left knee were normal, but magnetic resonance imaging revealed a multi-lobed cystic structure adjacent to the anterior cruciate ligament, which resembled a ganglion cyst. The mass was removed through arthroscopy, and pathological examination revealed a synovial cyst. Patient recovery was excellent, and he resumed his usual training routine five months later.

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