Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2016; 7(10): 638-649
Published online Oct 18, 2016. doi: 10.5312/wjo.v7.i10.638
Magnetic resonance imaging after anterior cruciate ligament reconstruction: A practical guide
Alberto Grassi, James R Bailey, Cecilia Signorelli, Giuseppe Carbone, Andy Tchonang Wakam, Gian Andrea Lucidi, Stefano Zaffagnini
Alberto Grassi, Cecilia Signorelli, Giuseppe Carbone, Andy Tchonang Wakam, Gian Andrea Lucidi, Stefano Zaffagnini, Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
James R Bailey, Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University Medical Center, Durham, NC 27710, United States
Stefano Zaffagnini, Unita’ Operativa di Ortopedia, Dipartimento Rizzoli-Sicilia, 90011 Bagheria, Italy
Author contributions: Grassi A performed the majority of the writing; Signorelli C, Carbone G and Lucidi GA prepared the figures and tables; Tchonag Wakam A assisted in writing the paper; Zaffagnini S coordinated the writing of the paper and performed critical review; Bailey JR performed language correction and critical review of the contents.
Conflict-of-interest statement: There is no conflict of interest associated with the senior author or other coauthors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alberto Grassi, MD, Laboratorio di Biomeccanica ed Innovazione Teconologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy. alberto.grassi3@studio.unibo.it
Telephone: +39-05-16366507
Received: February 26, 2016
Peer-review started: February 26, 2016
First decision: May 13, 2016
Revised: June 22, 2016
Accepted: August 11, 2016
Article in press: August 15, 2016
Published online: October 18, 2016
Processing time: 229 Days and 6.3 Hours
Abstract

Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopedic procedures performed worldwide. In this regard, magnetic resonance imaging (MRI) represents a useful pre-operative tool to confirm a disruption of the ACL and to assess for potential associated injuries. However, MRI is also valuable post-operatively, as it is able to identify, in a non-invasive way, a number of aspects and situations that could suggest potential problems to clinicians. Graft signal and integrity, correct tunnel placement, tunnel widening, and problems with fixation devices or the donor site could all compromise the surgical outcomes and potentially predict the failure of the ACL reconstruction. Furthermore, several anatomical features of the knee could be associated to worst outcomes or higher risk of failure. This review provides a practical guide for the clinician to evaluate the post-surgical ACL through MRI, and to analyze all the parameters and features directly or indirectly related to ACL reconstruction, in order to assess for normal or pathologic conditions.

Keywords: Anterior cruciate ligament reconstruction; Magnetic resonance imaging; Graft; Tunnel; Failures; Complications; Anatomic

Core tip: There are several original studies and reviews in the literature that discuss magnetic resonance imaging (MRI) evaluation after anterior cruciate ligament (ACL) reconstruction. However, these are mostly focused on a single aspect such as graft signal intensity, tunnel placement, joint anatomy, or complications. This is a first known review to summarize all the aspects that should be evaluated through MRI after an ACL reconstruction, in order to perform a complete and global assessment of the post-operative status. The iconographic sections with practical and detailed explanation of measurements will serve as a useful reference for the MRI evaluation after ACL reconstruction in daily clinical practice.