Investig Magn Reson Imaging.  2016 Jun;20(2):95-104. 10.13104/imri.2016.20.2.95.

Evaluation of Knee Joint after Double-Bundle ACL Reconstruction with Three-Dimensional Isotropic MRI

Affiliations
  • 1Department of Radiology, Gachon University, Incheon, Korea. leesw1@gilhospital.com
  • 2Department of Orthopedics, Gachon University, Incheon, Korea.

Abstract

PURPOSE
To evaluate the knee joint after double-bundle anterior cruciate ligament (ACL) reconstruction with three-dimensional (3D) isotropic magnetic resonance (MR) image, and to directly compare the ACL graft findings on 3D MR with the clinical results.
MATERIALS AND METHODS
From January 2009 to December 2014, we retrospectively reviewed MRIs of 39 patients who had reconstructed ACL with double bundle technique. The subjects were examined using 3D isotropic proton-density sequence and routine two-dimensional (2D) sequence on 3.0T scanner. The MR images were qualitatively evaluated for the intraarticular curvature, graft tear, bony impingement, intraosseous tunnel cyst, and synovitis of anteromedial and posterolateral bundles (AMB, PLB). In addition anterior tibial translation, PCL angle, PCL ratio were quantitatively measured. KT arthrometric values were reviewed for anterior tibial translation as positive or negative. The second look arthroscopy results including tear and laxity were reviewed.
RESULTS
Significant correlations were found between an AMB tear on 3D-isotropic proton density MR images and arthroscopic proven AMB tear or laxity (P < 0.05). Also, a significant correlation was observed between increased PCL ratio on 3D isotropic MRI and the arthroscopic findings such as tear, laxities of grafts (P < 0.05). KT arthrometric results were found to be significantly correlated with AMB tears (P < 0.05) and tibial tunnel cysts (P < 0.05).
CONCLUSION
An AMB tear on 3D-isotropic MRI was correlated with arthroscopic results qualitatively and quantitatively. 3D isotropic MRI findings can aid the evaluation of ACL grafts after double bundle reconstruction.

Keyword

Anterior cruciate ligament (ACL) reconstruction; Double bundle technique; Three-dimensional (3D) magnetic resonance (MR) image

MeSH Terms

Anterior Cruciate Ligament
Arthroscopy
Humans
Knee Joint*
Knee*
Magnetic Resonance Imaging*
Protons
Retrospective Studies
Synovitis
Tears
Transplants
Protons

Figure

  • Fig. 1 Intraarticular curvature on reformatted MRI. (a) 3D proton density-weighted image (PDWI) was taken in a 42-year-old man 50 months after double-bundle reconstruction. A 3D PDWI shows straight intraarticular curvature of AMB (arrows) from femoral tunnel to tibial tunnel. (b) 3D proton density-weighted image (PDWI) was taken in a 31-year-old man 12 months after double-bundle reconstruction. A 3D PDWI shows smooth arc (arrows) of AMB graft. Small hypointense lesion (arrowhead) anterior to the graft indicates nodular synovitis. (c) 3D proton density-weighted image (PDWI) was taken in a 44-year-old man 25 months after double-bundle reconstruction. A 3D PDWI show angulation of the AMB, showing abrupt change of course in the distal bundle (arrows).

  • Fig. 2 Graft tears on reformatted MRI. (a) 3D proton density-weighted image (PDWI) was taken in a 52-year-old man 17 months after double-bundle reconstruction. A 3D PDWI show marginal fraying of PLB showing irregularity at the posterior margin of the distal graft just before it enters the tibial tunnel (arrow). (b) 3D proton density-weighted image (PDWI) was taken in a 30-year-old man 14 months after double-bundle reconstruction. A 3D PDWI show fluid component within the AMB, with disruption of proximal graft (black arrow). The white arrow indicates the rest of the ACL graft.

  • Fig. 3 3D proton density-weighted image (PDWI) was taken in a 21-year-old man 12 months after double-bundle reconstruction. A 3D PDWI show bony impingement (black arrow) of an AMB, showing bony spur from femoral condyle (white arrow) abutting the thin and posteriorly sagging graft.

  • Fig. 4 3D proton density-weighted image (PDWI) was taken in a 38-year-old man 18 months after double-bundle reconstruction. A 3D PDWI show intraosseous cystic lesions in the femoral side of AMB (arrowhead) and the femoral and tibial side of PLB (arrows).

  • Fig. 5 3D proton density-weighted image (PDWI) was taken in a 43-year-old man 19 months after double-bundle reconstruction. A 3D PDWI show measurement of tibial translation on a MR image.

  • Fig. 6 3D proton density-weighted image (PDWI) was taken in a 43-year-old man 19 months after double-bundle reconstruction. A 3D PDWI show measurement of PCL angle (a), and PCL ratio (b).


Reference

1. Csintalan RP, Inacio MC, Funahashi TT. Incidence rate of anterior cruciate ligament reconstructions. Perm J. 2008; 12:17–21.
2. Bach BR Jr, Tradonsky S, Bojchuk J, Levy ME, Bush-Joseph CA, Khan NH. Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation. Am J Sports Med. 1998; 26:20–29.
3. Shelbourne KD, Gray T. Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation. A two- to nine-year followup. Am J Sports Med. 1997; 25:786–795.
4. Asagumo H, Kimura M, Kobayashi Y, Taki M, Takagishi K. Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy. 2007; 23:602–609.
5. Tanaka Y, Yonetani Y, Shiozaki Y, et al. MRI analysis of single-, double-, and triple-bundle anterior cruciate ligament grafts. Knee Surg Sports Traumatol Arthrosc. 2014; 22:1541–1548.
6. Recht MP, Kramer J. MR imaging of the postoperative knee: a pictorial essay. Radiographics. 2002; 22:765–774.
7. Papakonstantinou O, Chung CB, Chanchairujira K, Resnick DL. Complications of anterior cruciate ligament reconstruction: MR imaging. Eur Radiol. 2003; 13:1106–1117.
8. Ishibashi Y, Tsuda E, Fukuda A, Tsukada H, Toh S. Stability evaluation of single-bundle and double-bundle reconstruction during navigated ACL reconstruction. Sports Med Arthrosc. 2008; 16:77–83.
9. Kim SI, Park HJ, Lee SY, et al. Usefulness of oblique coronal and sagittal MR images of the knee after double-bundle and selective anterior cruciate ligament reconstructions. Acta Radiol. 2015; 56:312–321.
10. Duc SR, Pfirrmann CW, Koch PP, Zanetti M, Hodler J. Internal knee derangement assessed with 3-minute three-dimensional isovoxel true FISP MR sequence: preliminary study. Radiology. 2008; 246:526–535.
11. Vahey TN, Hunt JE, Shelbourne KD. Anterior translocation of the tibia at MR imaging: a secondary sign of anterior cruciate ligament tear. Radiology. 1993; 187:817–819.
12. Gentili A, Seeger LL, Yao L, Do HM. Anterior cruciate ligament tear: indirect signs at MR imaging. Radiology. 1994; 193:835–840.
13. Liu SH, Osti L, Dorey F, Yao L. Anterior cruciate ligament tear. A new diagnostic index on magnetic resonance imaging. Clin Orthop Relat Res. 1994; 147–150.
14. Fleming BC, Brattbakk B, Peura GD, Badger GJ, Beynnon BD. Measurement of anterior-posterior knee laxity: a comparison of three techniques. J Orthop Res. 2002; 20:421–426.
15. Amis AA. The functions of the fibre bundles of the anterior cruciate ligament in anterior drawer, rotational laxity and the pivot shift. Knee Surg Sports Traumatol Arthrosc. 2012; 20:613–620.
16. Steckel H, Vadala G, Davis D, Fu FH. 2D and 3D 3-tesla magnetic resonance imaging of the double bundle structure in anterior cruciate ligament anatomy. Knee Surg Sports Traumatol Arthrosc. 2006; 14:1151–1158.
17. Bencardino JT, Beltran J, Feldman MI, Rose DJ. MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics. 2009; 29:2115–2126.
18. Ghazikhanian V, Beltran J, Nikac V, Feldman M, Bencardino JT. Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis. Skeletal Radiol. 2012; 41:1375–1379.
19. Neddermann A, Willbold E, Witte F, et al. Tunnel widening after anterior cruciate ligament reconstruction: an experimental study in sheep. Am J Sports Med. 2009; 37:1609–1617.
20. Naraghi AM, Gupta S, Jacks LM, Essue J, Marks P, White LM. Anterior cruciate ligament reconstruction: MR imaging signs of anterior knee laxity in the presence of an intact graft. Radiology. 2012; 263:802–810.
21. Zampeli F, Ntoulia A, Giotis D, et al. The PCL index is correlated with the control of rotational kinematics that is achieved after anatomic anterior cruciate ligament reconstruction. Am J Sports Med. 2014; 42:665–674.
22. Barcellona MG, Morrissey MC, Milligan P, Amis AA. The effect of thigh muscle activity on anterior knee laxity in the uninjured and anterior cruciate ligament-injured knee. Knee Surg Sports Traumatol Arthrosc. 2014; 22:2821–2829.
23. Arneja S, Leith J. Review article: Validity of the KT-1000 knee ligament arthrometer. J Orthop Surg (Hong Kong). 2009; 17:77–79.
Full Text Links
  • IMRI
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr