MRI EVALUATION OF ANTERIOR CRUCIATE LIGAMENT GRAFTS: PATTERNS AND OUTCOMES IN BANGLADESH
Main Article Content
Keywords
Anterior cruciate ligament, Graft integrity, Lysholm score, MRI, Outcomes
Abstract
Background: Anterior cruciate ligament (ACL) reconstruction is a prevalent orthopedic procedure. Magnetic resonance imaging (MRI) is the principal modality for post-operative graft evaluation, assessing its integrity, position, and potential complications in a non-invasive manner. Objective: To evaluate the MRI findings and functional outcomes of ACL reconstructions in a cohort of patients in Bangladesh. Methods: A prospective cross-sectional study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Popular Diagnostic Center (Savar), Super Medical Hospital (Savar) and Enam Medical College Hospital (Savar) from January 2019 to December 2020. A purposive sample of 57 patients who underwent post-ACL reconstruction was enrolled. MRI scans were evaluated for graft characteristics, and functional outcomes were assessed using the Lysholm Knee Score. Data were analyzed using SPSS version 23.0. Results: Analysis of 57 patients demonstrated that the majority (73.7%) of ACL grafts were intact on MRI, while 26.3% showed abnormalities. Non-anatomic tunnel placement was observed in a notable proportion of cases. The functional outcome, measured by the Lysholm score, averaged 84.2, indicating a good overall result. Notably, a strong and statistically significant inverse correlation (p < 0.001) was observed between the presence of graft abnormalities on MRI and lower functional scores. Conclusion: MRI is essential for evaluating ACL graft integrity, with findings strongly correlated to patient function. The identified failure rate highlights the need for refined surgical techniques and rehabilitation protocols to improve outcomes in this population.
References
[2] Ochi, Mitsuo, et al., eds. ACL injury and its treatment. No. 8556. Tokyo: Springer Japan, 2016.
[3] Cheatham, Seth A., and Darren L. Johnson. "Anticipating problems unique to revision ACL surgery." Sports medicine and arthroscopy review 21.2 (2013): 129-134.
[4] Webster, K., and J. Feller. "Exploring the high re-injury rate in younger patients undergoing anterior cruciate ligament reconstruction." Journal of Science and Medicine in Sport 20 (2017): e84.
[5] Lind, Martin, Frank Menhert, and Alma B. Pedersen. "Incidence and outcome after revision anterior cruciate ligament reconstruction: results from the Danish registry for knee ligament reconstructions." The American journal of sports medicine 40.7 (2012): 1551-1557.
[6] Wiggins, Amelia J., et al. "Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis." The American journal of sports medicine 44.7 (2016): 1861-1876.
[7] van Yperen, Daan T., et al. "Twenty-year follow-up study comparing operative versus nonoperative treatment of anterior cruciate ligament ruptures in high-level athletes." The American journal of sports medicine 46.5 (2018): 1129-1136.
[8] Naraghi, Ali, and Lawrence M. White. "Postoperative imaging in sports medicine." Essential Radiology for Sports Medicine. New York, NY: Springer New York, 2010. 173-197.
[9] Ma, Yong, et al. "Graft maturity of the reconstructed anterior cruciate ligament 6 months postoperatively: a magnetic resonance imaging evaluation of quadriceps tendon with bone block and hamstring tendon autografts." Knee Surgery, Sports Traumatology, Arthroscopy 23.3 (2015): 661-668.
[10] Li, Hong, et al. "MRI-based ACL graft maturity does not predict clinical and functional outcomes during the first year after ACL reconstruction." Knee Surgery, Sports Traumatology, Arthroscopy 25.10 (2017): 3171-3178.
[11] Biercevicz, Alison M., et al. "MRI volume and signal intensity of ACL graft predict clinical, functional, and patient-oriented outcome measures after ACL reconstruction." The American journal of sports medicine 43.3 (2015): 693-699.
[12] Gifstad, Tone, et al. "Inferior results after revision ACL reconstructions: a comparison with primary ACL reconstructions." Knee Surgery, Sports Traumatology, Arthroscopy 21.9 (2013): 2011-2018.
[13] Muller, Bart, et al. "Defining thresholds for the patient acceptable symptom state for the IKDC subjective knee form and KOOS for patients who underwent ACL reconstruction." The American journal of sports medicine 44.11 (2016): 2820-2826.
[14] Lysholm, Jack, and Jan Gillquist. "Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale." The American journal of sports medicine 10.3 (1982): 150-154.
[15] Herzog, Mackenzie M., et al. "Trends in incidence of ACL reconstruction and concomitant procedures among commercially insured individuals in the United States, 2002-2014." Sports Health 10.6 (2018): 523-531.
[16] Li, Hui, et al. "Association between magnetic resonance imaging–measured intercondylar notch dimensions and anterior cruciate ligament injury: A meta-analysis." Arthroscopy: The Journal of Arthroscopic & Related Surgery 34.3 (2018): 889-900.
[17] Zappia, M., et al. "Anterior cruciate ligament reconstruction: MR imaging findings." Musculoskeletal surgery 101.Suppl 1 (2017): 23-35.
[18] Kopf, Sebastian, et al. "Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography." JBJS 92.6 (2010): 1427-1431.
[19] Mohan, Rohith, et al. "Clinical outcomes in revision anterior cruciate ligament reconstruction: a meta-analysis." Arthroscopy: The Journal of Arthroscopic & Related Surgery 34.1 (2018): 289-300.
[20] Collins, Natalie J., et al. "Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS‐PS), Knee Outcome Survey Activities of Daily Living Scale (KOS‐ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS)." Arthritis care & research 63.S11 (2011): S208-S228.
[21] Cinque, Mark E., et al. "High rates of osteoarthritis develop after anterior cruciate ligament surgery: an analysis of 4108 patients." The American journal of sports medicine 46.8 (2018): 2011-2019.
[22] Øiestad, Britt Elin. "Knee osteoarthritis and knee function after anterior cruciate ligament reconstruction: Long-term results." (2011).
[23] Ageberg, Eva, and Ewa M. Roos. "The association between knee confidence and muscle power, hop performance, and postural orientation in people with anterior cruciate ligament injury." Journal of Orthopedic & Sports Physical Therapy 46.6 (2016): 477-482.
[24] Grindem, Hege, et al. "Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study." British journal of sports medicine 50.13 (2016): 804-808.
[25] Webster, Kate E., and Timothy E. Hewett. "Meta‐analysis of meta‐analyses of anterior cruciate ligament injury reduction training programs." Journal of Orthopedic Research® 36.10 (2018): 2696-2708.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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Mohammad Ali Kabir
Medical Officer, Department of Radiology & Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka.
A S M Shahidul Hossain
Consultant, Department of Radiology & Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka.
Zeeren Sultana Deepa
Medical Officer, Department of Radiology & Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka.
Nazrul Islam Mullah
Medical Officer, Department of Radiology & Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka.
Lt. Col. Sultana Parvin
Classified Specialist in Radiology & Imaging, Department of Radiology & Imaging Combined Military Hospital (CMH), Dhaka
Mahmud Hasan Mostofa Kamal
Assistant professor, Department of Radiology & Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka.