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Patients with both PL femoral tunnels in anatomical locations showed poorer graft maturation after double bundle ACLR 5 years postoperatively
ESSKA Academy. FUKUDA H. May 11, 2018; 218137
HIDEAKI FUKUDA
HIDEAKI FUKUDA
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Abstract
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Objectives: MRI graft signal intensity(SI) is a useful tool to evaluate graft maturation process in a noninvasive manner after ACL reconstruction(ACLR).In double bundle (DB) ACLR,some reports concluded patients with both anteromedial bundle(AMB) and posterolateral bundle (PLB) femoral tunnels in anatomic locations showed better graft maturation.The purpose of the present study was to evaluate the relationship between femoral tunnel position, and the SI changes on MRI in each bundle after DB ACLR using a hamstring tendon autograft during the first 5 years postoperatively.

Methods: From October 2010 to August 2012, a total of 415 consecutive DB ACLR were performed. The inclusion criteria were primary ACLR; semitendinosus grafts with diameter (AMB >6mm, PLB >5mm);a minimum 5-year follow-up; and patients who underwent MRI at 3,6,9 and 12 months, and also 18, 24,36,48 and 60 months postoperatively.A total of 40 patients (15 males, 25 females; mean age 26.9±9.2;range 13-42) included in this study. Femoral tunnel placement was examined by 3D CT at 3weeks postoperatively, and tunnel location was evaluated using quadrant method. We divided into two groups :Anatomical group (AG) vs Nonanatomical group(NG) in each bundle. We evaluated the serial changes and the difference of SI between AMB and PLB by MRI in two groups. The MRI was performed on a 1.5-T unit. To quantitatively determine the normalized SI of the ACL graft, the signal/noise quotient (SNQ) of each graft site was calculated using the following equation: SNQ = (signal of ACL graft - signal of PCL /signal of background). The MRI images were independently measured in a blinded fashion by two observers, and the averages were recorded.

Results: There were 30 cases of AMB, and 27 cases of PLB in AG. On the other hand, there were 10 cases of AMB, and 13 cases of PLB in NG. Regardless of CT classification, the mean SNQ value of the AMB continued to increase until 6 months (5.3±1.2) and decrease gradually and became well established by 1.5 years (3.3±0.5).The mean PLB-SNQ continued to increase until 9 months (6.2±1.1) and decrease gradually and became well established by 2 years (4.1±0.5) postoperatively. At the final visit, the mean AMB-SNQ is 3.2±0.2 in AG ,3.8±0.3 in NG, and the mean PLB-SNQ is 4.2±0.4 in AG, and 3.7±0.3 in NG. The mean AMB-SNQ in AG was significantly lower than that in NG. In contrast to AMB, the mean PLB-SNQ in AG was significantly higher than that in NG.

Conclusions: The SI on MRI of AMB in AG was significantly lower than in NG, indicating patients with AM femoral tunnels in anatomic locations showed better graft maturation than patients with tunnels in the nonanatomical location. On the contrary, PL femoral tunnels in anatomic femoral location showed substantially poorer maturation at 5 years postoperatively. This study revealed the quite different maturation process in SI on MRI might exist at different rates between AMB and PLB at midterm follow-up.PLB in anatomic location might have inferior graft maturity process.

Keywords:
Anterior Cruciate Ligament Reconstruction the signal/noise quotient (SNQ) femoral tunnel location
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