The relationship between graft synovialization and graft revascularization after ACL reconstruction: Assessment using dynamic contrast enhanced-MRI and second-look arthroscopy

Jun Ho Kim; Eunsun Oh; Young Cheol Yoon; Do Kyung Lee; Sung-Sahn Lee; Se Yong Song; Joon Ho Wang

doi:10.1016/j.ejrad.2020.109346

The relationship between graft synovialization and graft revascularization after ACL reconstruction: Assessment using dynamic contrast enhanced-MRI and second-look arthroscopy

Eur J Radiol. 2020 Dec:133:109346. doi: 10.1016/j.ejrad.2020.109346. Epub 2020 Oct 16.

Authors

Jun Ho Kim¹, Eunsun Oh², Young Cheol Yoon³, Do Kyung Lee⁴, Sung-Sahn Lee⁵, Se Yong Song⁶, Joon Ho Wang⁷

Affiliations

¹ Department of Orthopedic Surgery, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, South Korea. Electronic address: junojuno49@gmail.com.
² Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, South Korea. Electronic address: sophiaoes@naver.com.
³ Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: youngcheol.yoon@gmail.com.
⁴ Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea. Electronic address: dr-lee331@hanmail.net.
⁵ Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, South Korea. Electronic address: sungsahnlee@gmail.com.
⁶ Department of Orthopedic Surgery, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, South Korea. Electronic address: seysong@me.com.
⁷ Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences and Technology and Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, South Korea; Investigation Performed at the Department of Orthopedic Surgery, Samsung Medical Center, College of Sungkyunkwan University, Seoul, South Korea. Electronic address: mdwang88@gmail.com.

PMID: 33137594
DOI: 10.1016/j.ejrad.2020.109346

Abstract

Purpose: To assess graft vascularity via dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) at 1-year and 2-year postoperatively and to evaluate the relationship between the vascularity using DCE-MRI and the synovialization using second-look arthroscopy.

Materials and methods: Fifty-four patients from prospective data included who underwent anterior cruciate ligament reconstruction (ACLR) and DCE-MRI. The graft was divided into proximal, middle, and distal zones; average of three zones was calculated. Signal/noise quotient (SNQ) was measured on proton-density image and normalized area under the curve (nAUC) was calculated from DCE-MRI. The results at 1-year (SNQ-1 and nAUC-1) and 2-year (SNQ-2 and nAUC-2) postoperatively were compared between two time points. Forty-one patients underwent second-look arthroscopy were classified into three groups according to the synovialization: Excellent (n = 17), Fair (n = 16), and Poor (n = 8). The SNQs and nAUCs were compared between three groups.

Results: Fifty-four and 23 patients underwent DCE-MRI at 1-year and 2-year, respectively. A significant decrease was observed from nAUC_average-1 to nAUC_average-2 (95 % confidential interval, 0.4-2.3; P = .007). Both SNQ_average-1 and SNQ_average-2 were significantly lower in the excellent than in the poor (SNQ_average-1, P < .001; SNQ_average-2, P = .003). Both SNQ_average-1 and SNQ_average-2 were significantly lower in the fair than in the poor (SNQ_average-1, P=.032; SNQ_average-2, P = .012). Both nAUC_average-1 and nAUC_average-2 were significantly higher in the excellent than in the poor (nAUC_average-1, P < .001; nAUC_average-2, P = .010). The nAUC_average-1 was significantly higher in the excellent than the fair (nAUC_average-1, P < .001).

Conclusion: Well-synovialized grafts showed significantly lower SNQs and significantly higher nAUCs than did poor-synovialized grafts based on the second-look arthroscopic findings. We can indirectly infer from this result that well-synovialized grafts may have better biomechanical properties.

Keywords: Anterior cruciate ligament reconstruction; Area under the curve; Dynamic contrast-enhanced-magnetic resonance imaging; Second-look arthrocopy; Synovialization.

MeSH terms

Anterior Cruciate Ligament Injuries*
Arthroscopy*
Humans
Magnetic Resonance Imaging
Prospective Studies
Treatment Outcome