Postoperative Magnetic Resonance Imaging after Anterior Cruciate Ligament Reconstruction: An Overview and Practical Step-by-step Guide

Abstract

Anterior cruciate ligament (ACL) rupture is a frequently encountered injury among athletes, often requiring surgical intervention to restore knee stability. Magnetic resonance imaging (MRI) after ACL reconstruction is common, especially in the evaluation of clinical complications leading to knee instability, decreased range of motion, or pain. This article provides a detailed overview of normal and abnormal postoperative findings including a practical step-by-step guide for MRI assessment. MRI findings must be correlated with surgical technique, time interval from surgery to imaging, and clinical examination.

Keywords

anterior cruciate ligament reconstruction - postoperative magnetic resonance imaging - complications - step-by-step guide

Publication History

Article published online:
20 May 2024

• References

• 1 Collins MS, Unruh KP, Bond JR, Mandrekar JN. Magnetic resonance imaging of surgically confirmed anterior cruciate ligament graft disruption. Skeletal Radiol 2008; 37 (03) 233-243
• 2 Migliorini F, Torsiello E, Trivellas A, Eschweiler J, Hildebrand F, Maffulli N. Bone-patellar tendon-bone versus two- and four-strand hamstring tendon autografts for ACL reconstruction in young adults: a Bayesian network meta-analysis. Sci Rep 2023; 13 (01) 6883
• 3 Buerba RA, Boden SA, Lesniak B. Graft selection in contemporary anterior cruciate ligament reconstruction. JAAOS Glob Res Rev 2021;5(10):
• 4 Emerson CP, Bernstein JM, Nham F. et al. Magnetic resonance imaging of the quadriceps tendon autograft in anterior cruciate ligament reconstruction. Skeletal Radiol 2019; 48 (11) 1685-1696
• 5 Diermeier T, Tisherman R, Hughes J. et al. Quadriceps tendon anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28 (08) 2644-265
• 6 Mouarbes D, Menetrey J, Marot V, Courtot L, Berard E, Cavaignac E. Anterior cruciate ligament reconstruction: a systematic review and meta-analysis of outcomes for quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring-tendon autografts. Am J Sports Med 2019; 47 (14) 3531-3540
• 7 Roberts CC, Towers JD, Spangehl MJ, Carrino JA, Morrison WB, Advanced MR. Advanced MR imaging of the cruciate ligaments. Magn Reson Imaging Clin N Am 2007; 15 (01) 73-86
• 8 Dianat S, Bencardino JT. Postoperative magnetic resonance imaging of the knee ligaments. Magn Reson Imaging Clin N Am 2022; 30 (04) 703-722
• 9 Heuck A, Woertler K. Posttreatment imaging of the knee: cruciate ligaments and menisci. Semin Musculoskelet Radiol 2022; 26 (03) 230-241
• 10 Meredick RB, Vance KJ, Appleby D, Lubowitz JH. Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Am J Sports Med 2008; 36 (07) 1414-1421
• 11 Wu F, Colak C, Subhas N. Preoperative and postoperative magnetic resonance imaging of the cruciate ligaments. Magn Reson Imaging Clin N Am 2022; 30 (02) 261-275
• 12 Grassi A, Bailey JR, Signorelli C. et al. Magnetic resonance imaging after anterior cruciate ligament reconstruction: a practical guide. World J Orthop 2016; 7 (10) 638-649
• 13 Panos JA, Webster KE, Hewett TE. Anterior cruciate ligament grafts display differential maturation patterns on magnetic resonance imaging following reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020; 28 (07) 2124-2138
• 14 Zhang S, Liu S, Yang L, Chen S, Chen S, Chen J. Morphological changes of the femoral tunnel and their correlation with hamstring tendon autograft maturation up to 2 years after anterior cruciate ligament reconstruction using femoral cortical suspension. Am J Sports Med 2020; 48 (03) 554-564
• 15 Recht MP, Parker RD, Irizarry JM. Second time around: evaluating the postoperative anterior cruciate ligament. Magn Reson Imaging Clin N Am 2000; 8 (02) 285-297
• 16 Meyers AB, Haims AH, Menn K, Moukaddam H. Imaging of anterior cruciate ligament repair and its complications. AJR Am J Roentgenol 2010; 194 (02) 476-484
• 17 Bencardino JT, Beltran J, Feldman MI, Rose DJ. MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics 2009; 29 (07) 2115-2126
• 18 Somanathan A, Tandon A, Yang LW. Review of magnetic resonance imaging features of complications after anterior cruciate ligament reconstruction. Singapore Med J 2019; 60 (02) 63-68
• 19 Wilde J, Bedi A, Altchek DW. Revision anterior cruciate ligament reconstruction. Sports Health 2014; 6 (06) 504-518
• 20 Ficek K, Rajca J, Cholewiński J. et al. Analysis of intercondylar notch size and shape in patients with cyclops syndrome after anterior cruciate ligament reconstruction. J Orthop Surg Res 2021; 16 (01) 554
• 21 Fujii M, Furumatsu T, Miyazawa S. et al. Intercondylar notch size influences cyclops formation after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2015; 23 (04) 1092-1099
• 22 Svensson M, Kartus J, Ejerhed L, Lindahl S, Karlsson J. Does the patellar tendon normalize after harvesting its central third?: A prospective long-term MRI study. Am J Sports Med 2004; 32 (01) 34-38
• 23 Kartus J, Movin T, Karlsson J. Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy 2001; 17 (09) 971-980
• 24 Suijkerbuijk MAM, Reijman M, Lodewijks SJM, Punt J, Meuffels DE. Hamstring tendon regeneration after harvesting: a systematic review. Am J Sports Med 2015; 43 (10) 2591-2598
• 25 Tsifountoudis I, Bisbinas I, Kalaitzoglou I. et al. The natural history of donor hamstrings unit after anterior cruciate ligament reconstruction: a prospective MRI scan assessment. Knee Surg Sports Traumatol Arthrosc 2017; 25 (05) 1583-1590
• 26 Rispoli DM, Sanders TG, Miller MD, Morrison WB. Magnetic resonance imaging at different time periods following hamstring harvest for anterior cruciate ligament reconstruction. Arthroscopy 2001; 17 (01) 2-8
• 27 Ramos DM, Dhandapani R, Subramanian A, Sethuraman S, Kumbar SG. Clinical complications of biodegradable screws for ligament injuries. Mater Sci Eng C 2020; 109: 110423
• 28 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 (03) 802-810
• 29 Saupe N, White LM, Chiavaras MM. et al. Anterior cruciate ligament reconstruction grafts: MR imaging features at long-term follow-up–correlation with functional and clinical evaluation. Radiology 2008; 249 (02) 581-590
• 30 Waltz RA, Solomon DJ, Provencher MT. A radiographic assessment of failed anterior cruciate ligament reconstruction: can magnetic resonance imaging predict graft integrity?. Am J Sports Med 2014; 42 (07) 1652-1660
• 31 Horton LK, Jacobson JA, Lin J, Hayes CW. MR imaging of anterior cruciate ligament reconstruction graft. AJR Am J Roentgenol 2000; 175 (04) 1091-1097
• 32 Sauer S, Lind M. Bone tunnel enlargement after ACL reconstruction with hamstring autograft is dependent on original bone tunnel diameter. Surg J (NY) 2017; 3 (02) e96-e100
• 33 de Beus A, Koch JE, Hirschmann A, Hirschmann MT. How to evaluate bone tunnel widening after ACL reconstruction—a critical review. Muscles Ligaments Tendons J 2017; 7 (02) 230-239
• 34 Webster KE, Feller JA, Hameister KA. Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 2001; 9 (02) 86-91
• 35 Sanders TG. MR imaging of postoperative ligaments of the knee. Semin Musculoskelet Radiol 2002; 6 (01) 19-33
• 36 Mayr HO, Weig TG, Plitz W. Arthrofibrosis following ACL reconstruction–reasons and outcome. Arch Orthop Trauma Surg 2004; 124 (08) 518-522
• 37 Anderson MJ, Browning III WM, Urband CE, Kluczynski MA, Bisson LJ. A systematic summary of systematic reviews on the topic of the anterior cruciate ligament. Orthop J Sports Med 2016; 4 (03) 2325967116634074