MRI AT ONE AND MINIMUM TWO YEARS AFTER ACL RECONSTRUCTION DEMONSTRATES THAT HAMSTRING GRAFTS HEAL AND INTEGRATE AT DIFFERENT RATES

Putnis S, Klasan A, Oshima T, et al. MRI AT ONE AND MINIMUM TWO YEARS AFTER ACL RECONSTRUCTION DEMONSTRATES THAT HAMSTRING GRAFTS HEAL AND INTEGRATE AT DIFFERENT RATES. Orthop Procs. 2022;104-B(SUPP_7):15-15. doi:10.1302/1358-992X.2022.7.015

Putnis, S., et al. “MRI AT ONE AND MINIMUM TWO YEARS AFTER ACL RECONSTRUCTION DEMONSTRATES THAT HAMSTRING GRAFTS HEAL AND INTEGRATE AT DIFFERENT RATES.” Orthopaedic Proceedings, vol. 104-B, no. SUPP_7, 2022, pp. 15-15., https://doi.org/10.1302/1358-992X.2022.7.015

Putnis, S., Klasan, A., Oshima, T., Grasso, S., Neri, T., Coolican, M., Fritsch, B., & Parker, D. (2022). MRI AT ONE AND MINIMUM TWO YEARS AFTER ACL RECONSTRUCTION DEMONSTRATES THAT HAMSTRING GRAFTS HEAL AND INTEGRATE AT DIFFERENT RATES. Orthopaedic Proceedings, 104-B(SUPP_7), 15-15. https://doi.org/10.1302/1358-992X.2022.7.015

Putnis, S., Klasan, A., Oshima, T., Grasso, S., Neri, T., Coolican, M. et al. (2022) “MRI AT ONE AND MINIMUM TWO YEARS AFTER ACL RECONSTRUCTION DEMONSTRATES THAT HAMSTRING GRAFTS HEAL AND INTEGRATE AT DIFFERENT RATES.” Orthopaedic Proceedings, 104-B(SUPP_7), pp. 15-15. Available at: https://doi.org/10.1302/1358-992X.2022.7.015

Putnis, S., A. Klasan, T. Oshima, S. Grasso, T. Neri, M. Coolican, B. Fritsch, and D. Parker. “MRI AT ONE AND MINIMUM TWO YEARS AFTER ACL RECONSTRUCTION DEMONSTRATES THAT HAMSTRING GRAFTS HEAL AND INTEGRATE AT DIFFERENT RATES.” Orthopaedic Proceedings 104-B, no. SUPP_7 (2022): 15-15. https://doi.org/10.1302/1358-992X.2022.7.015

Putnis S, Klasan A, Oshima T, Grasso S, Neri T, Coolican M, et al. MRI AT ONE AND MINIMUM TWO YEARS AFTER ACL RECONSTRUCTION DEMONSTRATES THAT HAMSTRING GRAFTS HEAL AND INTEGRATE AT DIFFERENT RATES. Orthop Procs. 2022 Jul 1;104-B(SUPP_7):15-15. https://doi.org/10.1302/1358-992X.2022.7.015

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Abstract

Introduction

MRI has been increasingly used as an outcome measure and proxy for healing and integration after ACL reconstruction (ACLR). Despite this, it has not yet been established what a steady state graft MRI appearance is.

Methodology

MRI and clinical outcome measures were prospectively taken at 1 and minimum 2 years after hamstring autograft ACLR. MRI graft signal was measured using novel reconstructions both parallel and perpendicular to the graft, with lower signal indicative of better healing and expressed as the signal intensity ratio (SIR), and tunnel apertures analysed.

Results

Forty-two patients were included. A proximal graft SIR of 1.9 at 1 year gave a sensitivity of 96% to remain unchanged. High SIR at 1 year, saw a significant reduction after 2 years (p=0.026), also correlated with a significant reduction in aperture area (tibial -6.9mm2, p< 0.001, femoral -13.5mm2, p< 0.001). Mean Tegner activity score was 6 [5-10] with a third of patients scoring either a 9 or 10. Overall, PROMs and knee laxity was not affected by MRI appearance.

Conclusion

A proximal graft SIR under 2 at 1 year is a sensitive indicator for a stable graft signal, implying healing. For those that do have high signal at 1 year, a significant reduction is seen in the second year, indicative of ongoing healing. A reduction in tunnel aperture area correlates with a reduction in graft SIR suggesting this could also be a useful measure of graft integration.