Correlation between graft maturity and knee function after anterior cruciate ligament reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Rongjin ^1,2 , GU Xinyi ¹ ,  XIANG Xianxiang ²

1. Emergency Department of Orthopedics, the Affiliated Chengdu Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu Sichuan, 611130, P.R.China;
2. Department of Sports Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian Liaoning, 116001, P.R.China;

Corresponding?author：

XIANG Xianxiang, Email: xiang13105@126.com

Keywords：

Knee; anterior cruciate ligament; ligament reconstruction; graft maturity; knee function; correlation study

DOI：

10.7507/1002-1892.202101100

Video：

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Objective To investigate the correlation between graft maturity and knee function after anterior cruciate ligament (ACL) reconstruction.Methods A total of 50 patients who underwent ACL reconstruction with autologous tendons between August 2016 and August 2018 were included in the study. There were 28 males and 22 females, with an average age of 31.0 years (range, 18-50 years). At 6 months and 2 years after operation, the signal to noise quotient (SNQ) values of tibial and femoral ends of graft were measured by MRI, and the mean value was taken as the SNQ value of graft. The function of knee joint was evaluated by Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores. The differences in SNQ values between tibial and femoral ends were analyzed at 6 months and 2 years after operation. The correlation between SNQ value at 6 months after operation and knee function score at 2 years after operation was analyzed. According to SNQ value at 6 months after operation, the patients were divided into group A (SNQ value≥12) and group B (SNQ value<12) and the correlation between SNQ value and knee function score was further analyzed.Results All incisions healed primarily without infection or injury of blood vessels and nerves. All patients were followed up 24-28 months (mean, 26.6 months). The IKDC, Lysholm, and Tegner scores at 6 months and 2 years after operation were significantly higher than those before operation (P<0.05), and all scores at 2 years after operation were also significantly higher than those at 6 months (P<0.05). The SNQ values at 6 months and 2 years after operation were 12.517±6.272 and 10.900±6.012, respectively, and the difference was significant (t=1.838, P=0.007). The SNQ values of graft at 6 months after operation were significantly different from those at 2 years after operation (P<0.05), and the SNQ values of tibial and femoral ends of graft at the same time point were significantly different (P<0.05). The SNQ value of 50 patients at 6 months after operation was negatively correlated with Lysholm, IKDC, and Tegner scores at 2 years after operation (r=–0.965, P=0.000; r=–0.896, P=0.000; r=–0.475, P=0.003). The patients were divided into groups A and B according to the SNQ value, each with 25 cases; the SNQ values of the two groups at 6 months after operation were negatively correlated with Lysholm, IKDC, and Tegner scores at 2 years after operation (P<0.05).Conclusion After ACL reconstruction, the knee function scores and graft maturity of patients gradually improved. The lower the SNQ value in the early stage, the higher the knee function score in the later stage. The SNQ value of MRI in the early stage after ACL reconstruction can predict the knee function in the later stage.

Citation： CHEN Rongjin, GU Xinyi, XIANG Xianxiang. Correlation between graft maturity and knee function after anterior cruciate ligament reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(6): 704-709. doi: 10.7507/1002-1892.202101100 Copy

1.	Kochhal N, Thakur R, Gawande V. Incidence of anterior cruciate ligament injury in a rural tertiary care hospital. J Family Med Prim Care, 2019, 8(12): 4032-4035.
2.	Weitz FK, Sillanp?? PJ, Mattila VM. The incidence of paediatric ACL injury is incred. asing in Finlan. Knee Surg Sports Traumatol Arthrosc, 2020, 28(2): 363-368.
3.	Magnitskaya N, Mouton C, Gokeler A, et al. Younger age and hamstring tendon graft are associated with higher IKDC 2000 and KOOS scores during the first year after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2020, 28(3): 823-832.
4.	Ouillette R, Edmonds E, Chambers H, et al. Outcomes of revision anterior cruciate ligament surgery in adolescents. Am J Sports Med, 2019, 47(6): 1346-1352.
5.	Li Q, Zhang Y, Zhan L, et al. Correlation analysis of magnetic resonance imaging-based graft maturity and outcomes after anterior cruciate ligament reconstruction using International Knee Documentation Committee Score. Am J Phys Med Rehabil, 2019, 98(5): 387-391.
6.	Weiler A, Peters G, M?urer J, et al. Biomechanical properties and vascularity of an anterior cruciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging. A two-year study in sheep. Am J Sports Med, 2001, 29(6): 751-761.
7.	Liu S, Li H, Tao H, et al. A randomized clinical trial to evaluate attached hamstring anterior cruciate ligament graft maturity with magnetic resonance imaging. Am J Sports Med, 2018, 46(5): 1143-1149.
8.	Zhang Y, Liu S, Chen Q, et al. Maturity progression of the entire anterior cruciate ligament graft of insertion-preserved hamstring tendons by 5 years: a prospective randomized controlled study based on magnetic resonance imaging evaluation. Am J Sports Med, 2020, 48(12): 2970-2977.
9.	Traven SA, Reeves RA, Xerogeanes JW, et al. Higher BMI predicts additional surgery at the time of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2019, 27(8): 2552-2557.
10.	Ahn JH, Lee SH, Choi SH, et al. Magnetic resonance imaging evaluation of anterior cruciate ligament reconstruction using quadrupled hamstring tendon autografts: comparison of remnant bundle preservation and standard technique. Am J Sports Med, 2010, 38(9): 1768-1777.
11.	Rahardja R, Zhu M, Love H, et al. Factors associated with revision following anterior cruciate ligament reconstruction: A systematic review of registry data. Knee, 2020, 27(2): 287-299.
12.	Li HY, Li H, Wu ZY, et al. MRI-based tendon bone healing is related to the clinical functional scores at the first year after anterior cruciate ligament reconstruction with hamstring tendon autograft. Knee Surg Sports Traumatol Arthrosc, 2018, 26(2): 615-621.
13.	Wen Z, Zhang H, Yan W, et al. Oval femoral tunnel technique is superior to the conventional round femoral tunnel technique using the hamstring tendon in anatomical anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2020, 28(7): 2245-2254.
14.	Claes S, Verdonk P, Forsyth R, et al. The “ligamentization” process in anterior cruciate ligament reconstruction: what happens to the human graft? A systematic review of the literature. Am J Sports Med, 2011, 39(11): 2476-2483.
15.	Muller B, Bowman KF, Bedi A. ACL graft healing and biologics. Clin Sports Med, 2013, 32(1): 93-109.
16.	陳榮進, 王衛明, 向先祥, 等. 富血小板血漿對前交叉韌帶重建術后移植物成熟度影響的臨床研究. 中國運動醫學雜志, 2020, 39(4): 257-262.
17.	劉鵬鶴, 代志鵬, 趙甲軍, 等. 自體血纖維蛋白凝塊對前交叉韌帶重建術后腱-骨愈合影響的臨床研究. 中國修復重建外科雜志, 2017, 31(7): 799-804.
18.	Kawakami Y, Takayama K, Matsumoto T, et al. Anterior cruciate ligament-derived stem cells transduced with BMP2 accelerate graft-bone integration after ACL reconstruction. Am J Sports Med, 2017, 45(3): 584-597.
19.	Nakase J, Kitaoka K, Toratani T, et al. Grafted tendon healing in femoral and tibial tunnels after anterior cruciate ligament reconstruction. J Orthop Surg (Hong Kong), 2014, 22(1): 65-69.

1. Kochhal N, Thakur R, Gawande V. Incidence of anterior cruciate ligament injury in a rural tertiary care hospital. J Family Med Prim Care, 2019, 8(12): 4032-4035.
2. Weitz FK, Sillanp?? PJ, Mattila VM. The incidence of paediatric ACL injury is incred. asing in Finlan. Knee Surg Sports Traumatol Arthrosc, 2020, 28(2): 363-368.
3. Magnitskaya N, Mouton C, Gokeler A, et al. Younger age and hamstring tendon graft are associated with higher IKDC 2000 and KOOS scores during the first year after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2020, 28(3): 823-832.
4. Ouillette R, Edmonds E, Chambers H, et al. Outcomes of revision anterior cruciate ligament surgery in adolescents. Am J Sports Med, 2019, 47(6): 1346-1352.
5. Li Q, Zhang Y, Zhan L, et al. Correlation analysis of magnetic resonance imaging-based graft maturity and outcomes after anterior cruciate ligament reconstruction using International Knee Documentation Committee Score. Am J Phys Med Rehabil, 2019, 98(5): 387-391.
6. Weiler A, Peters G, M?urer J, et al. Biomechanical properties and vascularity of an anterior cruciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging. A two-year study in sheep. Am J Sports Med, 2001, 29(6): 751-761.
7. Liu S, Li H, Tao H, et al. A randomized clinical trial to evaluate attached hamstring anterior cruciate ligament graft maturity with magnetic resonance imaging. Am J Sports Med, 2018, 46(5): 1143-1149.
8. Zhang Y, Liu S, Chen Q, et al. Maturity progression of the entire anterior cruciate ligament graft of insertion-preserved hamstring tendons by 5 years: a prospective randomized controlled study based on magnetic resonance imaging evaluation. Am J Sports Med, 2020, 48(12): 2970-2977.
9. Traven SA, Reeves RA, Xerogeanes JW, et al. Higher BMI predicts additional surgery at the time of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2019, 27(8): 2552-2557.
10. Ahn JH, Lee SH, Choi SH, et al. Magnetic resonance imaging evaluation of anterior cruciate ligament reconstruction using quadrupled hamstring tendon autografts: comparison of remnant bundle preservation and standard technique. Am J Sports Med, 2010, 38(9): 1768-1777.
11. Rahardja R, Zhu M, Love H, et al. Factors associated with revision following anterior cruciate ligament reconstruction: A systematic review of registry data. Knee, 2020, 27(2): 287-299.
12. Li HY, Li H, Wu ZY, et al. MRI-based tendon bone healing is related to the clinical functional scores at the first year after anterior cruciate ligament reconstruction with hamstring tendon autograft. Knee Surg Sports Traumatol Arthrosc, 2018, 26(2): 615-621.
13. Wen Z, Zhang H, Yan W, et al. Oval femoral tunnel technique is superior to the conventional round femoral tunnel technique using the hamstring tendon in anatomical anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2020, 28(7): 2245-2254.
14. Claes S, Verdonk P, Forsyth R, et al. The “ligamentization” process in anterior cruciate ligament reconstruction: what happens to the human graft? A systematic review of the literature. Am J Sports Med, 2011, 39(11): 2476-2483.
15. Muller B, Bowman KF, Bedi A. ACL graft healing and biologics. Clin Sports Med, 2013, 32(1): 93-109.
16. 陳榮進, 王衛明, 向先祥, 等. 富血小板血漿對前交叉韌帶重建術后移植物成熟度影響的臨床研究. 中國運動醫學雜志, 2020, 39(4): 257-262.
17. 劉鵬鶴, 代志鵬, 趙甲軍, 等. 自體血纖維蛋白凝塊對前交叉韌帶重建術后腱-骨愈合影響的臨床研究. 中國修復重建外科雜志, 2017, 31(7): 799-804.
18. Kawakami Y, Takayama K, Matsumoto T, et al. Anterior cruciate ligament-derived stem cells transduced with BMP2 accelerate graft-bone integration after ACL reconstruction. Am J Sports Med, 2017, 45(3): 584-597.
19. Nakase J, Kitaoka K, Toratani T, et al. Grafted tendon healing in femoral and tibial tunnels after anterior cruciate ligament reconstruction. J Orthop Surg (Hong Kong), 2014, 22(1): 65-69.

Chinese Journal of Reparative and Reconstructive Surgery

Correlation between graft maturity and knee function after anterior cruciate ligament reconstruction

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