Influence of Age on Signal Intensity Process of Magnetic Resonance Imaging and Clinical Outcomes in Double-Bundle Anterior Cruciate Ligament Reconstruction: Comparisons Among Different Age Groups

2021 ◽  
pp. 036354652110591
Author(s):  
Masahiko Saito ◽  
Tsuguo Morikawa ◽  
Junichi Iwasaki ◽  
Hiroaki Hosokawa ◽  
Takuya Sakamoto ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Acl Reconstruction ◽  
Signal Intensity ◽  
Older Patients ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Resonance Imaging ◽  
Age Related

Background: Thus far, the clinical results of anterior cruciate ligament (ACL) reconstruction have been observed to be comparable between young and older patients. In contrast, age-related changes in the structural and mechanical properties of tendons used for autografts have been described. However, age-related changes associated with graft maturation remain poorly understood. Hypotheses: The hypotheses of this study were that (1) clinical outcomes after ACL reconstruction would be comparable between younger and relatively older patients and (2) younger patients would show lower signal intensity changes on magnetic resonance imaging scans indicative of graft maturation that would be better than that in relatively older patients. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively evaluated 236 patients who underwent double-bundle ACL reconstruction via the outside-in technique using hamstring autograft between January 2012 and December 2015. The patients were categorized by age into 3 groups: <20 years old, 20 to 39 years old, and ≥40 years old. Clinical outcomes were evaluated using the subjective International Knee Documentation Committee (IKDC) score, Tegner activity scale, Lysholm score, and objective assessment of joint laxity 24 months after surgery. In addition, graft maturation was evaluated using magnetic resonance imaging–derived measures of the signal intensity ratio (SIR) at 3, 6, 12, and 24 months postoperatively. Clinical outcomes and graft maturation were compared among the 3 groups. Results: The SIR of both bundles increased from 3 months to 12 months and decreased by 24 months, showing the same tendency in all groups. No significant difference was found in the SIR among the 3 groups at any time point ( P > .05). The IKDC score was significantly lower in the ≥40-year group than in the <20-year group ( P < .01). In contrast, no significant differences were noted in other clinical outcomes. Conclusion: Patients aged ≥40 years exhibited lower IKDC scores compared with younger patients, although the results of graft maturation were comparable.

Magnetic resonance imaging of degenerative changes of the posterior cruciate ligament

2016 ◽  
Vol 58 (3) ◽  
pp. 338-343 ◽  
Author(s):  
Ferdinando Draghi ◽  
Chandra Bortolotto ◽  
Davide Renato Coscia ◽  
Mario Canepari ◽  
Salvatore Gitto
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Posterior Cruciate Ligament ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Degenerative Changes ◽  
Resonance Imaging ◽  
Mucoid Degeneration ◽  
Mri Findings ◽  
Magnetic Resonance Imaging Mri

Background Mucoid degeneration and ganglia reflect a continuum of degenerative changes within the posterior cruciate ligament (PCL). Purpose To assess the prevalence of and radiologists’ familiarity with PCL mucoid degeneration and ganglia. Material and Methods Knee magnetic resonance imaging (MRI) from July 2013 to June 2015, excluding patients who had a preceding trauma or MRI findings indicative of a prior injury, were retrospectively reviewed, with the specific request to assess degenerative changes of the PCL, by the same musculoskeletal radiologists who previously reported these examinations, and one fellow. Results A total of 692 patients entered this study. The radiologists and the fellow together identified mucoid degeneration in 34 patients (4.9%), ganglia in 14 patients (2.0%), and both in four patients (0.6%). Several patterns of PCL mucoid degeneration were identified: diffuse thickening in seven patients, partial thickening in 16 (four associated with a ganglion), longitudinal intraligamentous PCL signal-intensity abnormalities resembling a “tram track” in 15. In all cases there was increased signal intensity on fluid-sensitive sequences. In the previous reports, only three cases of PCL mucoid degeneration out of 38 (7.9%) were described, with intraligamentous PCL signal-intensity abnormalities. In the reports of the patients with degeneration and ganglia, only ganglia were described. In the previous reports, ganglia were correctly diagnosed. Conclusion Mucoid degeneration of the PCL is much more common than previously assumed and is underestimated by radiologists.

Biomechanical Properties and Vascularity of an Anterior Cruciate Ligament Graft can be Predicted by Contrast-Enhanced Magnetic Resonance Imaging

2001 ◽  
Vol 29 (6) ◽  
pp. 751-761 ◽  
Author(s):  
Andreas Weiler ◽  
Gunnar Peters ◽  
Jürgen Mäurer ◽  
Frank N. Unterhauser ◽  
Norbert P. Südkamp
Keyword(s):  
Magnetic Resonance Imaging ◽  
Tensile Strength ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Signal Intensity ◽  
Cruciate Ligament ◽  
Resonance Imaging ◽  
Contrast Enhanced ◽  
Load To Failure ◽  
Anterior Cruciate

Magnetic resonance imaging has been used to determine graft integrity and study the remodeling process of anterior cruciate ligament grafts morphologically in humans. The goal of the present study was to compare graft signal intensity and morphologic characteristics on magnetic resonance imaging with biomechanical and histologic parameters in a long-term animal model. Thirty sheep underwent anterior cruciate ligament reconstruction with an autologous Achilles tendon split graft and were sacrificed after 6, 12, 24, 52, or 104 weeks. Before sacrifice, all animals underwent plain and contrast-enhanced (gadolinium-diethylenetriamine pentacetic acid) magnetic resonance imaging (1.5 T, proton density weighted, 2-mm sections) of their operated knees. The signal/noise quotient was calculated and data were correlated to the maximum load to failure, tensile strength, and stiffness of the grafts. The vascularity of the grafts was determined immunohistochemically by staining for endothelial cells (factor VIII). We found that high signal intensity on magnetic resonance imaging reflects a decrease of mechanical properties of the graft during early remodeling. Correlation analyses revealed significant negative linear correlations between the signal/noise quotient and the load to failure, stiffness, and tensile strength. In general, correlations for contrast-enhanced measurements of signal intensity were stronger than those for plain magnetic resonance imaging. Immunohistochemistry confirmed that contrast medium enhancement reflects the vascular status of the graft tissue during remodeling. We conclude that quantitatively determined magnetic resonance imaging signal intensity may be a useful tool for following the graft remodeling process in a noninvasive manner.

Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance Imaging in Patients With Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 45 (10) ◽  
pp. 2233-2237 ◽  
Author(s):  
Nicholas N. DePhillipo ◽  
Mark E. Cinque ◽  
Jorge Chahla ◽  
Andrew G. Geeslin ◽  
Lars Engebretsen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Bone Bruise ◽  
Resonance Imaging ◽  
Tibial Bone ◽  
Ramp Lesion ◽  
Anterior Cruciate

Background: Meniscal ramp lesions have been reported to be present in 9% to 17% of patients undergoing anterior cruciate ligament (ACL) reconstruction. Detection at the time of arthroscopy can be accomplished based on clinical suspicion and careful evaluation. Preoperative assessment via magnetic resonance imaging (MRI) has been reported to have a low sensitivity in identifying meniscal ramp lesions. Purpose: To investigate the incidence of meniscal ramp lesions in patients with ACL tears and the sensitivity of preoperative MRI for the detection of ramp lesions. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent ACL reconstruction by a single surgeon between 2010 and 2016 were included in this study, and patients with medial meniscal ramp lesions found at the time of arthroscopy were identified. The sensitivity of MRI compared with the gold standard of arthroscopic evaluation was determined by review of the preoperative MRI musculoskeletal radiologist report, mimicking the clinical scenario. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. Results: In a consecutive series of 301 ACL reconstructions, 50 patients (33 male, 17 female) with a mean age of 29.6 years (range, 14-61 years) were diagnosed with a medial meniscal ramp lesion at arthroscopic evaluation (16.6% incidence). The sensitivity of MRI for ramp lesions was 48% based on the preoperative MRI report. A secondary finding of a posteromedial tibial bone bruise was identified on preoperative MRI in 36 of the 50 patients with ramp lesions in a retrospective MRI review by 2 orthopaedic surgeons. Conclusion: Medial meniscal ramp lesions were present in approximately 17% of 301 patients undergoing ACL reconstruction, and less than one-half were diagnosed on the preoperative MRI. A posteromedial tibial bone bruise was found to be a secondary sign of a ramp lesion in 72% of patients. Increased awareness of this potentially combined injury pattern is necessary, and careful intraoperative evaluation is required to identify all meniscal ramp tears.

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.

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