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Yücel MO, Dalaslan RE, Sağlam S, Karaduman ZO, Arıcan M, Akar B, Tural V. Comparison of a New Radiographic Technique with MRI Measurements for Tibial Tunnel Evaluation in ACL Reconstruction. Diagnostics (Basel) 2025; 15:1237. [PMID: 40428229 PMCID: PMC12110315 DOI: 10.3390/diagnostics15101237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2025] [Revised: 05/01/2025] [Accepted: 05/08/2025] [Indexed: 05/29/2025] Open
Abstract
Background/Objectives: The correct angular placement of the tibial tunnel is crucial to ensure graft tension, maintain knee stability, and ensure optimal clinical outcomes after anterior cruciate ligament (ACL) reconstruction. While 3D imaging methods such as MRI and CT are the gold standard for evaluating tunnel positioning, their routine use is limited by cost, availability, and time constraints. In clinical practice, 2D radiographs are more accessible but lack established reliability in accurately estimating tunnel angles. The aim of this study was to convert 2D radiographic angular measurements used in the evaluation of patients undergoing anterior cruciate ligament reconstruction into 3D values with a simple method and to compare these measurements with three-dimensional angles calculated using conventional MRI and CT. Methods: This retrospective study included 38 patients who underwent anatomic anterior cruciate ligament reconstruction. Postoperative radiographs and MR images were analyzed to determine the tibial tunnel angles. The angles calculated from 2D radiographs were statistically analyzed for their correlation with the actual 3D angles measured by MRI. Results: The analysis showed a strong correlation between tibial tunnel angles from radiographs and MRI, with minimal, non-significant differences. This suggests that radiographs can provide a reliable estimate of tibial tunnel angles. Conclusions: These findings suggest that radiographs can predict tibial tunnel angles in ACL reconstruction as accurately as MRI. This method can guide the correct tunnel angle and facilitate postoperative evaluation. Further studies are needed to confirm these results across various populations and techniques.
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Affiliation(s)
- Mücahid Osman Yücel
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Duzce University, 81620 Duzce, Türkiye
| | - Raşit Emin Dalaslan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Duzce University, 81620 Duzce, Türkiye
| | - Sönmez Sağlam
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Duzce University, 81620 Duzce, Türkiye
| | - Zekeriya Okan Karaduman
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Duzce University, 81620 Duzce, Türkiye
| | - Mehmet Arıcan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Duzce University, 81620 Duzce, Türkiye
| | - Bedrettin Akar
- Department of Orthopedics and Traumatology, Sakarya Yenikent State Hospital, 54290 Sakarya, Türkiye
| | - Volkan Tural
- Department of Orthopedics and Traumatology, Usak Training and Research Hospital, 64100 Usak, Türkiye
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D'Ambrosi R, Sconfienza LM, Albano D, Meena A, Abermann E, Fink C. Can MRI predict return to sport after anterior cruciate ligament reconstruction? A systematic review of the literature. LA RADIOLOGIA MEDICA 2025; 130:638-649. [PMID: 40063165 DOI: 10.1007/s11547-025-01973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 02/14/2025] [Indexed: 05/27/2025]
Abstract
PURPOSE To analyze whether magnetic resonance imaging (MRI) can predict return to sport after anterior cruciate ligament (ACL) reconstruction and whether a correlation exists between return to sports, level of activity and MRI signals. METHODS The search terms selected for inclusion in the title, abstract, and keyword fields were as follows: 'anterior cruciate ligament' OR 'ACL' AND 'graft maturation' OR 'MRI' AND 'return to sport' OR 'sports activity.' For each study, patient data and the MRI protocol used to assess graft maturation were extracted. An analysis of the correlations between MRI and ACL reconstruction was performed. RESULTS A total of 394 patients were included from 7 studies. The mean radiological follow-up was 19.06 ± 11.02 months. Three studies reported no correlations between graft bending angle, signal/noise ratio, signal intensity or Howell score and return to sport. One study revealed that T2* was correlated with return to sport. A further investigation demonstrated that those who were able to regain their preinjury athletic performance exhibited considerably lower ACL/PCL ratio and ACL/muscle ratio of the ACL mid-substance compared to those who were unable to attain the same level of athletic performance. Only one study reported correlations between 12-month SNRs and 60-month Cincinnati, Lysholm and Tegner activity scales, whereas Biercevicz revealed that the combination of volume and the SI predicted the KOOS score at the 5-year follow-up. CONCLUSIONS There are no reliable radiological parameters available that correlate with return to sport after anterior cruciate ligament reconstruction, but MRI can potentially play a key role in closing this gap. LEVEL OF EVIDENCE Systematic review of level IV. STUDY REGISTRATION PROSPERO-CRD42024574365.
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Affiliation(s)
- Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, 20122, Milan, Italy
| | - Amit Meena
- Department of Orthopaedics, Shalby Hospital, Jaipur, India
| | - Elisabeth Abermann
- Gelenkpunkt-Sports and Joint Surgery FIFA Medical Centre of Excellence, Innsbruck, Austria
| | - Christian Fink
- Gelenkpunkt-Sports and Joint Surgery FIFA Medical Centre of Excellence, Innsbruck, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences Medical Informatics and Technology, Innsbruck, Austria
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Chen C, Jing Z, Li Z, Hu M, Bei C, Xin L. Comparative efficacy of different lengths of anterior cruciate ligament stump during reconstruction with peroneus longus tendon. BMC Surg 2025; 25:175. [PMID: 40269891 PMCID: PMC12020297 DOI: 10.1186/s12893-025-02913-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 04/11/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury affects individuals, and successful ACL helps patients return to an active lifestyle. This study compared the clinical effects of two treatment schemes of retention length ≥ 1/2 and < 1/2 of ACL stump in patients under reconstruction with peroneus longus tendon (PLT). METHODS A total of 34 patients with ACL injury of knee joint treated by unilateral ACL reconstruction with PLT were recruited in this study. They were divided into N1 (retention length of ACL stump ≥ 1/2) and N2 (retention length of ACL stump < 1/2) groups (n = 17 in each group). The knee joint proprioceptive threshold of passive motor perception was used to evaluate recovery of proprioception. The international knee documentation committee (IKDC) score, Lysholm score, and Tegner activity score (TAS) were used to evaluate knee joint functions. Lachman test, anterior drawer test (ADT), and pivot shift test (PST) were used to evaluate the stability of knee joint. Single-legged hop test and return-to-sport ratio were used to evaluate the movement ability. RESULTS In 6th month and 12th month after operation, the passive motor perception threshold in N1 group was better than than that in N2 group (p < 0.05). In 12th month after the operation, the return-to-sport ratio in N1 group was increased compared to the N2 group (p < 0.05). There were no significant differences in results of IKDC score, Lysholm score, TAS, Lachman test, ADT, or PST between the two groups in 6th month and 12th month after the operation (p > 0.05). In addition, no significant difference was found in the single-legged hop test between the two groups in the 12th month after operation (p > 0.05). CONCLUSION During ACL reconstruction with PLT, treatment strategy of ACL stump retention length ≥ 1/2 is more effective than treatment strategy of length < 1/2 for patients with ACL injury of the knee joint.
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Affiliation(s)
- Chunrong Chen
- Department of Limb Trauma and Hand Surgery, Affiliated Hospital of Guilin Medical University, No.15 Lequn Road, Xiufeng District, Guilin City, Guangxi Zhuang Autonomous Region, 541001, China
| | - Zhang Jing
- Clinical Teaching and Training Center, Affiliated Hospital of Guilin Medical University, No.15 Lequn Road, Xiufeng District, Guilin City, Guangxi Zhuang Autonomous Region, 541001, China
| | - Zhimin Li
- Department of Spinal Bone Surgery, Affiliated Hospital of Guilin Medical University, No.15 Lequn Road, Xiufeng District, Guilin City, Guangxi Zhuang Autonomous Region, 541001, China
| | - Minghua Hu
- Orthopaedics Department, The Second Affiliated Hospital of Guilin Medical University, No. 212 Renmin Road, Lingui District, Guilin City, Guangxi Zhuang Autonomous Region, 541199, China
| | - Chaoyong Bei
- Department of Limb Trauma and Hand Surgery, Affiliated Hospital of Guilin Medical University, No.15 Lequn Road, Xiufeng District, Guilin City, Guangxi Zhuang Autonomous Region, 541001, China
| | - Linwei Xin
- Orthopaedics Department, The Second Affiliated Hospital of Guilin Medical University, No. 212 Renmin Road, Lingui District, Guilin City, Guangxi Zhuang Autonomous Region, 541199, China.
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Giavaresi G, Sartori M, Baleani M, Brogini S, Erani P, Dallari D, Del Piccolo N, Ghezzi CE, Martini L, Parrilli A, Boschi A, Tanzi MC, Alessandrino A, Fini M, Freddi G, Farè S. Assessment of the advantages and limitations of an innovative silk fibroin scaffold for the reconstruction of the anterior cruciate ligament with preclinical in vitro and in vivo evaluations. BIOMATERIALS ADVANCES 2025; 166:214029. [PMID: 39276659 DOI: 10.1016/j.bioadv.2024.214029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/19/2024] [Accepted: 09/06/2024] [Indexed: 09/17/2024]
Abstract
The gold standard treatment in anterior cruciate ligament (ACL) reconstruction involves autologous tissue transplantation, but this can have complications. Artificial grafts are an alternative, but the best option is debated. This study aimed to assess the biocompatibility and integration of a silk fibroin textile prosthesis (SF-TP) with peri-implant bone tissue and the native ACL. Twenty-six sheep underwent ACL reconstruction with SF-TP or autologous femoral fascia lata (FFL). Sheep were divided into two groups (3 and 6 months) and retrieved joints processed for histological, morphometrical and mechanical analysis. In vitro, SF-TP showed no cytotoxicity and good cell interaction up to 14 days. Histology revealed fibro-vascular tissue around SF-TP, with a progressive attempt of ligamentous-like tissue formation at 6 months. However, SF-TP group had higher joint damage scores. Micro-CT showed tunnel enlargement in SF-TP group, while FFL group had a decrease. SF-TP reconstructions had lower stiffness and strength (44 % and 64 % decrease) than those of autologous FFL reconstruction and often failed by pull-out from the bone tunnel due to tunnel enlargement. These results indicate poor osteointegration and graft motion with SF-TP, leading to joint damage/bone resorption and reduced mechanical competence. These results do not support the use of SF-TP for ACL reconstruction.
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Affiliation(s)
- Gianluca Giavaresi
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Sartori
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Brogini
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Erani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Dante Dallari
- Chirurgia Ortopedica Ricostruttiva Tecniche Innovative - Banca del Tessuto Muscoloscheletrico (BTM)- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicolandrea Del Piccolo
- Chirurgia Ortopedica Ricostruttiva Tecniche Innovative - Banca del Tessuto Muscoloscheletrico (BTM)- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Chiara E Ghezzi
- Dipartimento Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Milano, Italy
| | - Lucia Martini
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Annapaola Parrilli
- Center for X-Ray Analytics, Empa - Swiss Federal Laboratories for Materials Science & Technology, Dübendorf, Switzerland
| | | | - Maria Cristina Tanzi
- Dipartimento Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Milano, Italy
| | | | - Milena Fini
- Direzione Scientifica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuliano Freddi
- Innovhub - Stazioni Sperimentali per l'Industria, Milano, Italy
| | - Silvia Farè
- Dipartimento Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Milano, Italy
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Bajaj S, Chhabra A, Taneja AK. 3D isotropic MRI of ankle: review of literature with comparison to 2D MRI. Skeletal Radiol 2024; 53:825-846. [PMID: 37978990 DOI: 10.1007/s00256-023-04513-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
The ankle joint has complex anatomy with different tissue structures and is commonly involved in traumatic injuries. Magnetic resonance imaging (MRI) is the primary imaging modality used to assess the soft tissue structures around the ankle joint including the ligaments, tendons, and articular cartilage. Two-dimensional (2D) fast spin echo/turbo spin echo (FSE/TSE) sequences are routinely used for ankle joint imaging. While the 2D sequences provide a good signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) with high spatial resolution, there are some limitations to their use owing to the thick slices, interslice gaps leading to partial volume effects, limited fluid contrast, and the need to acquire separate images in different orthogonal planes. The 3D MR imaging can overcome these limitations and recent advances have led to technical improvements that enable its widespread clinical use in acceptable time periods. The volume imaging renders the advantage of reconstructing into thin continuous slices with isotropic voxels enabling multiplanar reconstructions that helps in visualizing complex anatomy of the structure of interest throughout their course with improved sharpness, definition of anatomic variants, and fluid conspicuity of lesions and injuries. Recent advances have also reduced the acquisition time of the 3D datasets making it more efficient than 2D sequences. This article reviews the recent technical developments in the domain 3D MRI, compares imaging with 3D versus 2D sequences, and demonstrates the use-case scenarios with interesting cases, and benefits of 3D MRI in evaluating various ankle joint components and their lesions.
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Affiliation(s)
- Suryansh Bajaj
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Johns Hopkins University, Baltimore, MD, USA
- Walton Center of Neurosciences, Liverpool, UK
- University of Dallas, Richardson, TX, USA
| | - Atul Kumar Taneja
- Musculoskeletal Radiology Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
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Cheraya G, Chhabra A. Cruciate and Collateral Ligaments: 2-Dimensional and 3-Dimensional MR Imaging-Aid to Knee Preservation Surgery. Semin Ultrasound CT MR 2023; 44:271-291. [PMID: 37437967 DOI: 10.1053/j.sult.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Being a major load-bearing and dynamic functional joint of the body, the knee joint is prone to injuries to the menisci and ligaments. Injury to one or more of these structures leads to accelerated or premature osteoarthritis and chronic debilitation. The estimated cost of these injuries in terms of diagnosis, treatment, rehabilitation, and person-hours lost amounts to over a billion dollars annually. Understanding the relevant anatomy of knee cruciate and collateral ligaments, their biomechanical functional role, and imaging considerations are essential to assist multi-disciplinary communications and timely patient treatments for improved management. MRI is considered the gold standard over other imaging modalities like X-ray, ultrasound (US), and Computed Tomography (CT) for diagnosing and assessing such injuries. High-resolution 2D and 3D MRI are considerably helpful in planning for knee preservation surgery, and this article reviews the role of such imaging as a valuable aid to knee preservation surgery in pre-and post-operative states. Relevant arthroscopy correlations have been illustrated.
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Affiliation(s)
- Gaurav Cheraya
- Department of Radiology, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT
| | - Avneesh Chhabra
- Musculoskeletal Radiology Division and Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX; Radiology, Adjunct faculty- Johns Hopkins University, Baltimore, MD; Radiology, Walton Center of Neurosciences, Liverpool, UK; Biomedical Engineering, University of Dallas, Dallas, TX.
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Abstract
Acute knee injury ranges among the most common joint injuries in professional and recreational athletes. Radiographs can detect joint effusion, fractures, deformities, and malalignment; however, MR imaging is most accurate for radiographically occult fractures, chondral injury, and soft tissue injuries. Using a structured checklist approach for systematic MR imaging evaluation and reporting, this article reviews the MR imaging appearances of the spectrum of traumatic knee injuries, including osteochondral injuries, cruciate ligament tears, meniscus tears and ramp lesions, anterolateral complex and collateral ligament injuries, patellofemoral translation, extensor mechanism tears, and nerve and vascular injuries.
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