Sufficient MRI graft structural integrity at 9 months after anterior cruciate ligament reconstruction with hamstring tendon autograft
Purpose To assess the MRI-measured structural integrity of hamstring autograft at 9 months after anterior cruciate ligament reconstruction (ACLR) surgery. Methods A prospective cohort study was conducted including 34 patients (mean age 36.8 ± 11.8 years; 73.5% males) who underwent ACLR with hamstrin...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2022-06, Vol.30 (6), p.1893-1900 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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| creator | Malahias, Michael-Alexander Capece, Francesco Maria Ballarati, Claudio Viganò, Marco Marano, Marco Hofbauer, Marcus Togninalli, Danilo de Girolamo, Laura Denti, Matteo |
| description | Purpose
To assess the MRI-measured structural integrity of hamstring autograft at 9 months after anterior cruciate ligament reconstruction (ACLR) surgery.
Methods
A prospective cohort study was conducted including 34 patients (mean age 36.8 ± 11.8 years; 73.5% males) who underwent ACLR with hamstring autograft. In addition, 36 patients (mean age 39.2 ± 10.5 years; 69.4% males) without any ACL injury were also reviewed and served as control group. The primary outcome used for examining graft maturity at 9 months after ACLR was the MRI-based signal-to-noise quotient (SNQ) of reconstructed ACL. SNQ values were stratified into 3 different categories: excellent: |
| doi_str_mv | 10.1007/s00167-021-06830-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2621017941</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2621017941</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2202-b9678b882d19752db3a1d147f9efffa28349da888e1dbb35cf0043f6a98e99d13</originalsourceid><addsrcrecordid>eNp9kc9u1DAQhy1ERZeFF-BQWeLCJXRsJ7F9RFULlYqQ-udsOYm96yqxF9tRtS_Ac_AsPBnephSJAydb42--seaH0DsCHwkAP00ApOUVUFJBKxhU9AVakZqxirOav0QrkDWtKDTtMXqd0j1AudbyFTpmDTApiVyhHzezta53xmf89foSb6K2Gacc5z7PUY_Y-Ww20eU91hnLXz-n4PM24UKZiHV5jC5E3Bfe6Wzw6DZ6Osii6YNfPC54_ODyFm_1VCrOb3A2fihVPefwOPENOrJ6TObt07lGdxfnt2dfqqtvny_PPl1VPaVAq062XHRC0IFI3tChY5oMpOZWGmutpoLVctBCCEOGrmNNbwFqZlsthZFyIGyNPizeXQzfZ5OymlzqzThqb8KcFG0pAcJlfUDf_4Pehzn68rtCtVw2lJWlrxFdqD6GlKKxahfdpONeEVCHlNSSkiopqceUFC1NJ0_quZvM8NzyJ5YCsAVIu8O6TPw7-z_a30m8oIc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2667952368</pqid></control><display><type>article</type><title>Sufficient MRI graft structural integrity at 9 months after anterior cruciate ligament reconstruction with hamstring tendon autograft</title><source>Springer Nature - Complete Springer Journals</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Malahias, Michael-Alexander ; Capece, Francesco Maria ; Ballarati, Claudio ; Viganò, Marco ; Marano, Marco ; Hofbauer, Marcus ; Togninalli, Danilo ; de Girolamo, Laura ; Denti, Matteo</creator><creatorcontrib>Malahias, Michael-Alexander ; Capece, Francesco Maria ; Ballarati, Claudio ; Viganò, Marco ; Marano, Marco ; Hofbauer, Marcus ; Togninalli, Danilo ; de Girolamo, Laura ; Denti, Matteo</creatorcontrib><description>Purpose
To assess the MRI-measured structural integrity of hamstring autograft at 9 months after anterior cruciate ligament reconstruction (ACLR) surgery.
Methods
A prospective cohort study was conducted including 34 patients (mean age 36.8 ± 11.8 years; 73.5% males) who underwent ACLR with hamstring autograft. In addition, 36 patients (mean age 39.2 ± 10.5 years; 69.4% males) without any ACL injury were also reviewed and served as control group. The primary outcome used for examining graft maturity at 9 months after ACLR was the MRI-based signal-to-noise quotient (SNQ) of reconstructed ACL. SNQ values were stratified into 3 different categories: excellent: < 0.1; good: ≥ 0.1 and ≤ 0.19; fair: ≥ 0.2. The KT-1000 knee arthrometer was used to measure the side-to-side difference in the anterior tibial translation between the ACLR knee and the contralateral healthy knee in the ACLR group.
Results
Reconstructed ACLs were found with a mean SNQ of 0.078 ± 0.061, while almost all ACL-reconstructed patients (97%; 33 out of 34) were found with excellent or good SNQ values (< 0.019). The mean KT-1000 in the ACLR group was 0.071 mm ± 0.926 mm, while there were no patients in the ACLR cohort with a KT-1000 value > 3 mm. The mean 9-months MRI-based SNQ of ACLR group was significantly higher compared to the mean MRI-based SNQ of the control group (
p
< 0.001). Multiple regression analysis showed no correlation between SNQ and age, gender, time from injury to ACLR, graft size, or simultaneous treatment of additional intra-articular knee lesions.
Conclusions
In this cohort of 34 ACL-reconstructed patients, 97% of hamstring tendon autografts demonstrated excellent/good MRI signal intensity and excellent functional results (KT-1000 < 3 mm) at 9 months after surgery. Based on this finding, it is suggested that return to sports after ACLR with hamstring autograft can be considered safe at 9 months post surgery. Furthermore, while structural integrity of the graft has been achieved at this time point, statistical differences found in SNQ values of ACL-reconstructed patients compared to ACLs of healthy individuals highlight the continuing process of graft maturation and remodelling.
Level of evidence
Level III.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-021-06830-2</identifier><identifier>PMID: 35039919</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Age ; Anterior cruciate ligament ; Autografts ; Grafting ; Injuries ; Knee ; Ligaments ; Magnetic resonance imaging ; Males ; Medicine ; Medicine & Public Health ; Multiple regression analysis ; Orthopedics ; Patients ; Quotients ; Sports Medicine ; Statistical analysis ; Structural integrity ; Surgery</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022-06, Vol.30 (6), p.1893-1900</ispartof><rights>The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2021</rights><rights>2021. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).</rights><rights>The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2202-b9678b882d19752db3a1d147f9efffa28349da888e1dbb35cf0043f6a98e99d13</citedby><cites>FETCH-LOGICAL-c2202-b9678b882d19752db3a1d147f9efffa28349da888e1dbb35cf0043f6a98e99d13</cites><orcidid>0000-0002-7027-0415</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-021-06830-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-021-06830-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35039919$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Malahias, Michael-Alexander</creatorcontrib><creatorcontrib>Capece, Francesco Maria</creatorcontrib><creatorcontrib>Ballarati, Claudio</creatorcontrib><creatorcontrib>Viganò, Marco</creatorcontrib><creatorcontrib>Marano, Marco</creatorcontrib><creatorcontrib>Hofbauer, Marcus</creatorcontrib><creatorcontrib>Togninalli, Danilo</creatorcontrib><creatorcontrib>de Girolamo, Laura</creatorcontrib><creatorcontrib>Denti, Matteo</creatorcontrib><title>Sufficient MRI graft structural integrity at 9 months after anterior cruciate ligament reconstruction with hamstring tendon autograft</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
To assess the MRI-measured structural integrity of hamstring autograft at 9 months after anterior cruciate ligament reconstruction (ACLR) surgery.
Methods
A prospective cohort study was conducted including 34 patients (mean age 36.8 ± 11.8 years; 73.5% males) who underwent ACLR with hamstring autograft. In addition, 36 patients (mean age 39.2 ± 10.5 years; 69.4% males) without any ACL injury were also reviewed and served as control group. The primary outcome used for examining graft maturity at 9 months after ACLR was the MRI-based signal-to-noise quotient (SNQ) of reconstructed ACL. SNQ values were stratified into 3 different categories: excellent: < 0.1; good: ≥ 0.1 and ≤ 0.19; fair: ≥ 0.2. The KT-1000 knee arthrometer was used to measure the side-to-side difference in the anterior tibial translation between the ACLR knee and the contralateral healthy knee in the ACLR group.
Results
Reconstructed ACLs were found with a mean SNQ of 0.078 ± 0.061, while almost all ACL-reconstructed patients (97%; 33 out of 34) were found with excellent or good SNQ values (< 0.019). The mean KT-1000 in the ACLR group was 0.071 mm ± 0.926 mm, while there were no patients in the ACLR cohort with a KT-1000 value > 3 mm. The mean 9-months MRI-based SNQ of ACLR group was significantly higher compared to the mean MRI-based SNQ of the control group (
p
< 0.001). Multiple regression analysis showed no correlation between SNQ and age, gender, time from injury to ACLR, graft size, or simultaneous treatment of additional intra-articular knee lesions.
Conclusions
In this cohort of 34 ACL-reconstructed patients, 97% of hamstring tendon autografts demonstrated excellent/good MRI signal intensity and excellent functional results (KT-1000 < 3 mm) at 9 months after surgery. Based on this finding, it is suggested that return to sports after ACLR with hamstring autograft can be considered safe at 9 months post surgery. Furthermore, while structural integrity of the graft has been achieved at this time point, statistical differences found in SNQ values of ACL-reconstructed patients compared to ACLs of healthy individuals highlight the continuing process of graft maturation and remodelling.
Level of evidence
Level III.</description><subject>Age</subject><subject>Anterior cruciate ligament</subject><subject>Autografts</subject><subject>Grafting</subject><subject>Injuries</subject><subject>Knee</subject><subject>Ligaments</subject><subject>Magnetic resonance imaging</subject><subject>Males</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Multiple regression analysis</subject><subject>Orthopedics</subject><subject>Patients</subject><subject>Quotients</subject><subject>Sports Medicine</subject><subject>Statistical analysis</subject><subject>Structural integrity</subject><subject>Surgery</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kc9u1DAQhy1ERZeFF-BQWeLCJXRsJ7F9RFULlYqQ-udsOYm96yqxF9tRtS_Ac_AsPBnephSJAydb42--seaH0DsCHwkAP00ApOUVUFJBKxhU9AVakZqxirOav0QrkDWtKDTtMXqd0j1AudbyFTpmDTApiVyhHzezta53xmf89foSb6K2Gacc5z7PUY_Y-Ww20eU91hnLXz-n4PM24UKZiHV5jC5E3Bfe6Wzw6DZ6Osii6YNfPC54_ODyFm_1VCrOb3A2fihVPefwOPENOrJ6TObt07lGdxfnt2dfqqtvny_PPl1VPaVAq062XHRC0IFI3tChY5oMpOZWGmutpoLVctBCCEOGrmNNbwFqZlsthZFyIGyNPizeXQzfZ5OymlzqzThqb8KcFG0pAcJlfUDf_4Pehzn68rtCtVw2lJWlrxFdqD6GlKKxahfdpONeEVCHlNSSkiopqceUFC1NJ0_quZvM8NzyJ5YCsAVIu8O6TPw7-z_a30m8oIc</recordid><startdate>202206</startdate><enddate>202206</enddate><creator>Malahias, Michael-Alexander</creator><creator>Capece, Francesco Maria</creator><creator>Ballarati, Claudio</creator><creator>Viganò, Marco</creator><creator>Marano, Marco</creator><creator>Hofbauer, Marcus</creator><creator>Togninalli, Danilo</creator><creator>de Girolamo, Laura</creator><creator>Denti, Matteo</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7027-0415</orcidid></search><sort><creationdate>202206</creationdate><title>Sufficient MRI graft structural integrity at 9 months after anterior cruciate ligament reconstruction with hamstring tendon autograft</title><author>Malahias, Michael-Alexander ; Capece, Francesco Maria ; Ballarati, Claudio ; Viganò, Marco ; Marano, Marco ; Hofbauer, Marcus ; Togninalli, Danilo ; de Girolamo, Laura ; Denti, Matteo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2202-b9678b882d19752db3a1d147f9efffa28349da888e1dbb35cf0043f6a98e99d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Age</topic><topic>Anterior cruciate ligament</topic><topic>Autografts</topic><topic>Grafting</topic><topic>Injuries</topic><topic>Knee</topic><topic>Ligaments</topic><topic>Magnetic resonance imaging</topic><topic>Males</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Multiple regression analysis</topic><topic>Orthopedics</topic><topic>Patients</topic><topic>Quotients</topic><topic>Sports Medicine</topic><topic>Statistical analysis</topic><topic>Structural integrity</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Malahias, Michael-Alexander</creatorcontrib><creatorcontrib>Capece, Francesco Maria</creatorcontrib><creatorcontrib>Ballarati, Claudio</creatorcontrib><creatorcontrib>Viganò, Marco</creatorcontrib><creatorcontrib>Marano, Marco</creatorcontrib><creatorcontrib>Hofbauer, Marcus</creatorcontrib><creatorcontrib>Togninalli, Danilo</creatorcontrib><creatorcontrib>de Girolamo, Laura</creatorcontrib><creatorcontrib>Denti, Matteo</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Malahias, Michael-Alexander</au><au>Capece, Francesco Maria</au><au>Ballarati, Claudio</au><au>Viganò, Marco</au><au>Marano, Marco</au><au>Hofbauer, Marcus</au><au>Togninalli, Danilo</au><au>de Girolamo, Laura</au><au>Denti, Matteo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sufficient MRI graft structural integrity at 9 months after anterior cruciate ligament reconstruction with hamstring tendon autograft</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2022-06</date><risdate>2022</risdate><volume>30</volume><issue>6</issue><spage>1893</spage><epage>1900</epage><pages>1893-1900</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
To assess the MRI-measured structural integrity of hamstring autograft at 9 months after anterior cruciate ligament reconstruction (ACLR) surgery.
Methods
A prospective cohort study was conducted including 34 patients (mean age 36.8 ± 11.8 years; 73.5% males) who underwent ACLR with hamstring autograft. In addition, 36 patients (mean age 39.2 ± 10.5 years; 69.4% males) without any ACL injury were also reviewed and served as control group. The primary outcome used for examining graft maturity at 9 months after ACLR was the MRI-based signal-to-noise quotient (SNQ) of reconstructed ACL. SNQ values were stratified into 3 different categories: excellent: < 0.1; good: ≥ 0.1 and ≤ 0.19; fair: ≥ 0.2. The KT-1000 knee arthrometer was used to measure the side-to-side difference in the anterior tibial translation between the ACLR knee and the contralateral healthy knee in the ACLR group.
Results
Reconstructed ACLs were found with a mean SNQ of 0.078 ± 0.061, while almost all ACL-reconstructed patients (97%; 33 out of 34) were found with excellent or good SNQ values (< 0.019). The mean KT-1000 in the ACLR group was 0.071 mm ± 0.926 mm, while there were no patients in the ACLR cohort with a KT-1000 value > 3 mm. The mean 9-months MRI-based SNQ of ACLR group was significantly higher compared to the mean MRI-based SNQ of the control group (
p
< 0.001). Multiple regression analysis showed no correlation between SNQ and age, gender, time from injury to ACLR, graft size, or simultaneous treatment of additional intra-articular knee lesions.
Conclusions
In this cohort of 34 ACL-reconstructed patients, 97% of hamstring tendon autografts demonstrated excellent/good MRI signal intensity and excellent functional results (KT-1000 < 3 mm) at 9 months after surgery. Based on this finding, it is suggested that return to sports after ACLR with hamstring autograft can be considered safe at 9 months post surgery. Furthermore, while structural integrity of the graft has been achieved at this time point, statistical differences found in SNQ values of ACL-reconstructed patients compared to ACLs of healthy individuals highlight the continuing process of graft maturation and remodelling.
Level of evidence
Level III.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>35039919</pmid><doi>10.1007/s00167-021-06830-2</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7027-0415</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022-06, Vol.30 (6), p.1893-1900 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2621017941 |
| source | Springer Nature - Complete Springer Journals; Wiley Online Library Journals Frontfile Complete |
| subjects | Age Anterior cruciate ligament Autografts Grafting Injuries Knee Ligaments Magnetic resonance imaging Males Medicine Medicine & Public Health Multiple regression analysis Orthopedics Patients Quotients Sports Medicine Statistical analysis Structural integrity Surgery |
| title | Sufficient MRI graft structural integrity at 9 months after anterior cruciate ligament reconstruction with hamstring tendon autograft |
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