title: Effect of tunnel placements on clinical and magnetic resonance imaging findings 2 years after anterior cruciate ligament reconstruction using the double-bundle technique.
abstract: OBJECTIVE
  The purpose of the study reported here was to find out if the clinical and magnetic resonance imaging (MRI) findings of a reconstructed anterior cruciate ligament (ACL) have an association. Our hypothesis, which was based on the different functions of the ACL bundles, was that the visibility of the anteromedial graft would have an impact on anteroposterior stability, and the visibility of the posterolateral graft on rotational stability of the knee.
  
  
  METHODS
  This study is a level II, prospective clinical and MRI study (NCT02000258). The study involved 75 patients. One experienced orthopedic surgeon performed all double-bundle ACL reconstructions. Two independent examiners made the clinical examinations at 2-year follow-up: clinical examination of the knee; KT-1000, International Knee Documentation Committee and Lysholm knee evaluation scores; and International Knee Documentation Committee functional score. The MRI evaluations were made by two musculoskeletal radiologists separately, and the means of these measurements were used.
  
  
  RESULTS
  We found that the location of the graft in the tibia had an impact on the MRI visibility of the graft at 2-year follow-up. There were significantly more partially or totally invisible grafts if the insertion of the graft was more anterior in the tibia. No association was found between the clinical results and the graft locations.
  
  
  CONCLUSIONS
  Anterior graft location in the tibia can cause graft invisibility in the MRI 2 years after ACL reconstruction, but this has no effect on the clinical recovery of the patient.
authors.affiliation: Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland.
authors.forename: Piia
authors.initials: P
authors.lastname: Suomalainen
authors.affiliation: Medical Imaging Centre, Tampere University Hospital, Tampere, Finland.
authors.forename: Tommi
authors.initials: T
authors.lastname: Kiekara
authors.affiliation: Division of Orthopaedics and Traumatology, Department of Trauma, Musculoskeletal Surgery and Rehabilitation, Tampere University Hospital, Tampere, Finland.
authors.forename: Anna-Stina
authors.initials: AS
authors.lastname: Moisala
authors.affiliation: Medical Imaging Centre, Tampere University Hospital, Tampere, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Paakkala
authors.affiliation: Injury and Osteoporosis Research Center, UKK Institute, Tampere, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Kannus
authors.affiliation: Arthroscopic and Sports Medicine Center Omasairaala, Helsinki, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Järvelä
keywords: anteromedial graft; anteroposterior stability; clinical recovery; graft location; posterolateral graft; rotational stability; tibia