Allograft Maturation After Reconstruction of the Anterior Cruciate Ligament Is Dependent on Graft Parameters in the Sagittal Plane

Abstract

Background: Allograft healing (ligamentization) after reconstruction of the anterior cruciate ligament (ACL) is dependent on multiple factors, including tissue processing, host biologic environment, and biomechanical stressors. Magnetic resonance imaging (MRI) can be used to assess graft maturation after ACL reconstruction. Hypothesis: A significant difference will exist in the MRI analysis between 2 distinct allograft constructs. Specifically, the MRI signal-to-noise quotient (SNQ) value will be smaller in quadrupled hamstring tendon (HT) allografts compared with doubled tibialis anterior (TA) allografts due to the difference in graft geometry (surface area–to-volume ratio). Study Design: Cohort study; Level of evidence, 2. Methods: Prospectively collected data from a subset of patients who participated in a randomized controlled trial at a single center from July 2010 to April 2012 were reviewed. Patients underwent ACL reconstruction using either HT or TA allografts. Six months postoperatively, 32 patients underwent noncontrast MRI to assess ligamentization. The SNQ was calculated for the allograft using sagittal noncontrast T2-weighted MRI as follows: SNQ = ( S graft − S qaudriceps)/ S backgroud. Graft properties including sagittal and coronal angle as well as tibial and femoral tunnel location were measured. All participants completed validated patient-reported outcome measures preoperatively and at 2 years postoperatively. Results: The mean MRI SNQ for the HT and TA allografts was 2.56 ± 2.41 and 3.15 ± 3.38, respectively ( P = .57). For the entire group, there was a significant correlation between MRI SNQ and both sagittal graft angle ( P = .02) and sagittal tibial tunnel position ( P < .001). We did not find a significant correlation between the tibial tunnel location in the coronal plane, coronal graft angle, or location of the femoral tunnel and the MRI SNQ. Conclusion: Allograft ligamentization 6 months postoperatively, as assessed by MRI, is dependent on position of the tibial tunnel in the sagittal plane as well as sagittal graft orientation. We did not detect a difference in graft maturation at 6 months between the tibialis anterior and hamstring tendon allografts. This is the only study to our knowledge that directly compares quadrupled HT allografts and doubled TA allografts using postoperative MRI.