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European radiology
Aug, 2024;34 (8): 5007-5015.

Primary anterior cruciate ligament repair-morphological and quantitative assessment by 7-T MRI and clinical outcome after 1.5 years.

Milena L Pachowsky, Stefan Söllner, Kolja Gelse, Jannik Sambale, Armin M Nagel, Georg Schett, Marc Saake, Michael Uder, Frank W Roemer, Rafael Heiss
Author Information
  1. Milena L Pachowsky: Department of Internal Medicine 3 - Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany. milena.pachowsky@gmail.com. ORCID
  2. Stefan Söllner: Department of Trauma and Orthopaedic Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
  3. Kolja Gelse: Department of Trauma and Orthopaedic Surgery, Klinikum Traunstein, Traunstein, Germany.
  4. Jannik Sambale: Department of Internal Medicine 3 - Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
  5. Armin M Nagel: Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
  6. Georg Schett: Department of Internal Medicine 3 - Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
  7. Marc Saake: Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
  8. Michael Uder: Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
  9. Frank W Roemer: Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
  10. Rafael Heiss: Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
PMID: 38345606 DOI: 10.1007/s00330-024-10603-z

Abstract

OBJECTIVES: The purpose of this study was to assess morphological and quantitative changes of the anterior cruciate ligament (ACL) and cartilage after ACL repair.
METHODS: 7T MRI of the knee was acquired in 31 patients 1.5 years after ACL repair and in 13 controls. Proton density-weighted images with fat saturation (PD-fs) were acquired to assess ACL width, signal intensity, elongation, and fraying. T2/T2* mapping was performed for assessment of ACL and cartilage. Segmentation of the ACL, femoral, and tibial cartilage was carried out at 12 ROIs. The outcome evaluation consisted of the Lysholm Knee Score and International Knee Documentation Committee (IKDC) subjective score and clinical examination.
RESULTS: ACL showed a normal signal intensity in 96.8% and an increased width in 76.5% after repair. Fraying occurred in 22.6% without having an impact on the clinical outcome (Lysholm score: 90.39 ± 9.75, p = 0.76 compared to controls). T2 analysis of the ACL revealed no difference between patients and controls (p = 0.74). Compared to controls, assessment of the femoral and tibial cartilage showed a significant increase of T2* times in all ROIs, except at the posterolateral femur. Patients presented a good outcome in clinical examination with a Lysholm score of 87.19 ± 14.89 and IKDC of 80.23 ± 16.84.
CONCLUSION: T2 mapping results suggest that the tissue composition of the ACL after repair is similar to that of a native ACL after surgery, whereas the ACL exhibits an increased width. Fraying of the ACL can occur without having any impact on functional outcomes. T2* analysis revealed early degradation at the cartilage.
CLINICAL RELEVANCE STATEMENT: MRI represents a noninvasive diagnostic tool for the morphological and compositional assessment of the anterior cruciate ligament after repair, whereas knowledge about post-surgical alterations is crucial for adequate imaging interpretation.
KEY POINTS: • There has been renewed interest in repairing the anterior cruciate ligament with a proximally torn ligament. • T2 times of the anterior cruciate ligament do not differ between anterior cruciate ligament repair patients and controls. • T2 mapping may serve as a surrogate for the evaluation of the anterior cruciate ligament after repair.

Keywords

Cartilage Knee Ligaments Magnetic resonance imaging Orthopedics

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Grants

  1. FOR 2886/2 Project Z (405969122)/Deutsche Forschungsgemeinschaft

MeSH Term

Humans
Magnetic Resonance Imaging
Female
Male
Adult
Anterior Cruciate Ligament Reconstruction
Treatment Outcome
Anterior Cruciate Ligament Injuries
Middle Aged
Anterior Cruciate Ligament
Young Adult
Case-Control Studies
Cartilage, Articular
Adolescent
Journal Article
Article has an altmetric score of 2

Word Cloud

Created with Highcharts 10.0.0ACLligamentanteriorcruciaterepaircartilagecontrolsassessmentoutcomeclinicalT2MRIpatientswidthmappingLysholmKnee±•assessmorphologicalquantitativeacquired15yearssignalintensityfemoraltibialROIsevaluationIKDCscoreexaminationshowedincreased76Frayingwithoutimpactp =0analysisrevealedT2*timeswhereasimagingOBJECTIVES:purposestudychangesMETHODS:7Tknee3113Protondensity-weightedimagesfatsaturationPD-fselongationfrayingT2/T2*performedSegmentationcarried12consistedScoreInternationalDocumentationCommitteesubjectiveRESULTS:normal968%5%occurred226%score:9039975compareddifference74ComparedsignificantincreaseexceptposterolateralfemurPatientspresentedgood8719148980231684CONCLUSION:resultssuggesttissuecompositionsimilarnativesurgeryexhibitscanoccurfunctionaloutcomesearlydegradationCLINICALRELEVANCESTATEMENT:representsnoninvasivediagnostictoolcompositionalknowledgepost-surgicalalterationscrucialadequateinterpretationKEYPOINTS:renewedinterestrepairingproximallytorndiffermayservesurrogatePrimaryrepair-morphological7-TCartilageLigamentsMagneticresonanceOrthopedics

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