Grafted tendon healing in femoral and tibial tunnels after anterior cruciate ligament reconstruction.
OBJECTIVE
To evaluate tendon-to-bone healing after anterior cruciate ligament (ACL) reconstruction in the fibrous interzone (FIZ) of the femoral and tibial tunnels using magnetic resonance imaging (MRI).


METHODS
Five men and 5 women (mean age, 29 years) underwent arthroscopic ACL reconstruction by a single surgeon, using the semitendinosus and gracilis tendon. The tendon-to-bone healing in the FIZ was evaluated using sagittal and coronal MRI at 1, 3, 6, 9, 12, and 24 weeks, with the knee flexed at 60º and the tendon graft straight in both images. The signal intensity of the FIZ was visually assessed by comparing it with anatomic landmarks in the same patient's knee, and classified into 4 grades. It was grade 3 when similar to that of the patellar tendon, grade 2 when similar to that of skeletal muscle, grade 1 when greater than that of muscle but less than that of joint fluid, and grade 0 when similar to that of joint fluid. At 24 weeks, subjective and objective functional outcomes were evaluated using the Lysholm score and the International Knee Documentation Committee score.


RESULTS
At 24 weeks, no patient had knee laxity. All patients had an International Knee Documentation Committee score of A, and their mean Lysholm score was 98.5. In the femoral tunnel, the FIZ did not change during the first 9 weeks (in particular the anterior part), but healing occurred rapidly thereafter. In the tibial tunnel, the FIZ healed over time in all locations, and healing was complete in the lateral and posterior parts at 12 weeks, and in all locations at 24 weeks. The mean signal intensity grade was significantly higher in the tibial than femoral FIZ at 3 to 12 weeks (p<0.01).


CONCLUSIONS
After ACL reconstruction, the tendon-to- bone healing in the FIZ of the tibial tunnel was faster than that of the femoral tunnel.
Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
Junsuke
J
Nakase
Department of Orthopaedic Surgery, Kijima Hospital, Japan.
Katsuhiko
K
Kitaoka
Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
Tatsuhiro
T
Toratani
Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
Masahiro
M
Kosaka
Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
Yoshinori
Y
Ohashi
Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
Hiroyuki
H
Tsuchiya
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017847:Patellar Ligament / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing
anterior cruciate ligament reconstruction; magnetic resonance imaging