Use of Magnetic Resonance Imaging to Predict Quadrupled Semitendinosus Graft Diameter in All-Inside Anterior Cruciate Ligament Reconstruction

Background: Joint infection after anterior cruciate ligament (ACL) reconstruction is a rare but serious complication. Purpose: To assess the effect of joint infection on the graft, cartilage, and bone tunnel using magnetic resonance imaging (MRI) after arthroscopic single-bundle ACL reconstruction with autologous hamstring tendons. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective matched cohort study included 26 patients who underwent arthroscopic single-bundle ACL reconstruction with hamstring tendon graft at the authors’ institute between January 2002 and December 2017 and developed postoperative joint infection. These patients were matched 1:3 to patients who did not sustain joint infection after ACL reconstruction (control group). MRI scans were collected at the time of follow-up. The following parameters were evaluated: graft signal-to-noise quotient (SNQ); graft signal intensity at the bone-graft interface and within the knee joint; bone tunnel enlargement at the tunnel aperture, midsection, and exit of the tibial and femoral tunnels; and cartilage integrity. Results: The average follow-up time was 47.8 months in the infection group and 48.5 months in the control group. Compared with the control group, the infection group had a significantly higher SNQ (20.01 ± 12.08 vs 7.61 ± 6.70; P = .014) as well as a higher signal intensity at the bone-graft interface ( P = .037) and higher Howell grade ( P = .031). The mean enlargement at the femoral tunnel aperture was 31.20% ± 26.76% in the infection group and 19.22% ± 20.10% in the control group ( P = .037). The articular cartilage of the patellofemoral and lateral femorotibial joints showed more degenerative change in the infection group. Conclusion: Study findings indicated that graft ligamentization and incorporation graft maturity were inferior in patients who experienced a joint infection after ACL reconstruction compared with patients who did not.

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“…The higher SNQ in the infection group indicates diminished graft revascularization and biomechanical properties. 5 , 9 , 29 , 37 …”

Section: Discussionmentioning

confidence: 99%

Effect of Joint Infection After Arthroscopic Single-Bundle ACL Reconstruction With Autologous Hamstring Tendon: A Retrospective Matched MRI Study

Chen

Wang

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…It has been documented that only sex [ 23 ], height and lower limb length [ 11 , 24 ] correlate with the hamstring tendon CSA. However, imaging examinations, such as MRI [ 13 – 15 , 25 , 26 ] and ultrasonography [ 27 ], seem to provide the best estimation of tendon size before surgery. While the hamstring CSA can be measured by ultrasound, CT or MRI, of these three methods, MRI shows statistically better results [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Developmental changes in ACLs and semitendinosus tendons dimensions according to age in children

Tomaszewski

Smyczek²,

Woś-Cieśla

et al. 2020

J Orthop Surg Res

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Purpose Managing anterior cruciate ligament (ACL) injuries in skeletally immature patients remains difficult. The main aim of this study was to retrospectively compile normative data on the cross-sectional area (CSA) of the semitendinosus tendon (ST) and the diameter of the ACL in children and young adults. Methods Knee magnetic resonance imaging (MRI) examinations were performed for a 2-year period in 132 patients (83 female and 49 male patients). The mean age was 14.9 years (8–18 years). Measurements of the ST CSA were performed on axial views in greyscale by two independent researchers. The ACL diameter was measured as well. Results The results show the CSA of the ST was related to age, and its growth was not linear. The highest growth rate of the CSA of the ST occurred at age 12–13 at the level of the femoral growth plate and at the level of the tibial plateau. The growth of the ACL diameter was linear until 18 years of age. Conclusions ST growth (measured in CSA increments) is almost complete at the age of 13, even though the growth is not linear. ACL growth measured in diameter increments proceeds linearly from 8 to 18 years of age. MRI is a clinically useful tool for assessing hamstring tendon grafts preoperatively. Level of evidence Level III, diagnostic studies

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“…Previous studies have used measurements of the hamstring tendon at the level of the physis or physeal scar. 1,2,5,16,18 This level was arbitrarily chosen in a previous study by Bickel et al 2 along the tendon in which it is more tubular and easier to measure on MRI. We were able to objectively show that 3 cm above the joint line had the highest correlation with the actual graft size.…”

Section: Discussionmentioning

confidence: 99%

“…11 The other imaging-based studies utilizing MRI used cross-sectional area to determine the expected QH graft diameter; however, only a moderate correlation was achieved. 2,4,5,7,16,18 This is likely because a nonlinear relationship exists between the individual hamstring tendon diameters and the actual QH graft size.…”

mentioning

confidence: 99%

Can We Accurately Predict the Quadruple Hamstring Graft Diameter From Preoperative Magnetic Resonance Imaging?

Vardiabasis¹,

Mosier

Walters

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:Anterior cruciate ligament (ACL) reconstruction with a quadruple hamstring (QH) autograft is a widely utilized procedure with good outcomes. A graft diameter less than 8 mm, however, has been associated with higher revision rates. Accurately determining the diameter of the hamstring tendon preoperatively can help surgeons plan accordingly.Purpose/Hypothesis:The purpose of our study was to determine whether QH graft size can be reliably predicted from preoperative magnetic resonance imaging (MRI) measurements. We hypothesized that we can achieve a high predicted QH graft size correlation with regard to preoperative and intraoperative measurements.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:We evaluated patients undergoing ACL reconstruction using QH autografts. At the time of surgery, the semitendinosus tendon (ST) and gracilis tendon (GT) were harvested and sized and then sized as a QH graft. Preoperative individual ST and GT sizes were determined from T2-weighted fat-saturated MRI at 3 cm above the joint line using correlating axial and coronal images. We then used a predictive chart to predict what the size of the QH graft would be and compared this with the actual measurements. Pearson correlation coefficients between predicted and actual graft sizes were calculated.Results:The predicted GT graft size was within 0.5 mm of the actual size in 45 of 60 (75%) patients and within 1 mm of the actual graft size in 59 of 60 (98%) patients. The predicted GT graft size from MRI measurements correlated with the actual GT graft size (r = 0.62, P < .00001). The predicted ST graft size was within 0.5 mm of the actual size in 45 of 60 (75%) patients and within 1 mm of the actual graft size in 56 of 60 (93%) patients. The predicted ST graft size from MRI measurements correlated with the actual ST graft size (r = 0.71, P < .00001). The predicted QH graft size was within 0.5 mm of the actual size in 52 of 60 (87%) patients and within 1 mm of the actual graft size in 60 of 60 (100%) patients. The predicted QH graft size from MRI measurements correlated with the actual QH graft size (r = 0.81, P < .00001).Conclusion:The current technique can reliably predict the size of a QH graft within 1 mm of the final graft size.

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Use of Magnetic Resonance Imaging to Predict Quadrupled Semitendinosus Graft Diameter in All-Inside Anterior Cruciate Ligament Reconstruction

Cited by 12 publications

References 13 publications

Effect of Joint Infection After Arthroscopic Single-Bundle ACL Reconstruction With Autologous Hamstring Tendon: A Retrospective Matched MRI Study

Effect of Joint Infection After Arthroscopic Single-Bundle ACL Reconstruction With Autologous Hamstring Tendon: A Retrospective Matched MRI Study

Developmental changes in ACLs and semitendinosus tendons dimensions according to age in children

Can We Accurately Predict the Quadruple Hamstring Graft Diameter From Preoperative Magnetic Resonance Imaging?

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