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, 6 (10), 2325967118800298

Contrast-Enhanced MRI Evaluation of Bone-Patellar Tendon-Bone and Hamstring ACL Autograft Healing in Humans: A Prospective Randomized Study


Contrast-Enhanced MRI Evaluation of Bone-Patellar Tendon-Bone and Hamstring ACL Autograft Healing in Humans: A Prospective Randomized Study

Dana Curtis Covey et al. Orthop J Sports Med.


Background: Gadopentetate dimeglumine-enhanced magnetic resonance imaging (MRI), or gadolinium-enhanced MRI, was used to prospectively study the postoperative course of bone-patellar tendon-bone (BPTB) and combined semitendinosus and gracilis (STG) tendon autografts following arthroscopically assisted reconstruction of the anterior cruciate ligament (ACL) in humans. Gadopentetate dimeglumine is a contrast agent that has been shown to enhance the signal of vascularized tissue when examined by MRI.

Purpose: To prospectively determine and compare the pattern and timing of autograft revascularization following arthroscopically assisted ACL reconstruction by BPTB or STG autografts.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 73 patients (63 males, 10 females) with ACL tears who were scheduled to undergo reconstruction consented to participate in this study. The patients were randomized to receive arthroscopically assisted reconstruction of the ACL employing either BPTB or STG autografts. Gadolinium-enhanced MRI scans were scheduled at 3-month intervals during the first postoperative year to assess the integrity, timing, and pattern of enhancement of the ACL graft. The temporal sequence and morphologic characteristics of imaged signals were compared for both types of ACL reconstructions.

Results: Based on all knees with 1 exception, there were no statistically significant differences in gadopentetate dimeglumine-mediated graft enhancement grade observed between BPTB and STG autografts.

Conclusion: The results suggest that autograft revascularization probably varies in intensity and location during the time course of graft healing. The interval signal changes observed 3 to 9 months, but especially 6 to 9 months, postoperatively are due to increased contrast uptake as a reflection of ongoing neovascularization during the process of ligamentization.

Keywords: ACL graft healing; MRI; autograft; revascularization.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This investigation was supported by Naval Medical Research and Development Command (grant B2EW.00095.008.9311). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.


Figure 1.
Figure 1.
Patient flow diagram. ACL, anterior cruciate ligament; BPTB, bone–patellar tendon–bone; MRA, magnetic resonance arthrogram; STG, semitendinosus and gracilis.
Figure 2.
Figure 2.
Examples of gadolinium enhancement (arrows) in the 3 zones of study: (A) no zone enhancement, (B) grade I tibial zone enhancement, (C) grade II femoral zone enhancement, and (D) grade III intra-articular zone enhancement.
Figure 3.
Figure 3.
Mean enhancement grades for bone–patellar tendon–bone (BPTB) and semitendinosus and gracilis (STG) graft types at 3, 6, and 9 months postoperatively for the tibial, intra-articular, and femoral zones. The asterisk (*) shows a significant difference (P = .028) between graft types per the rank-sum test. Twelve-month grades are not shown, because the BPTB group had only 1 patient.

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