Association of Graft Maturity on MRI With Return to Sports at 9 Months After Primary Single-Bundle ACL Reconstruction With Autologous Hamstring Graft

Tianping Zhou; Yihong Xu; Aiai Zhang; Xuchao Zhang; Kehan Deng; Haoran Wu; Weidong Xu

doi:10.1177/23259671241248202

Association of Graft Maturity on MRI With Return to Sports at 9 Months After Primary Single-Bundle ACL Reconstruction With Autologous Hamstring Graft

Orthop J Sports Med. 2024 May 9;12(5):23259671241248202. doi: 10.1177/23259671241248202. eCollection 2024 May.

Authors

Tianping Zhou¹, Yihong Xu¹, Aiai Zhang², Xuchao Zhang¹, Kehan Deng³, Haoran Wu⁴, Weidong Xu¹

Affiliations

¹ Department of Joint Surgery and Sports Medicine, Changhai Hospital affiliated to Navy Medical University, Shanghai, China.
² Department of Burn Surgery, Changhai Hospital affiliated to Navy Medical University, Shanghai, China.
³ Department of Stomatology, Changhai Hospital affiliated to Navy Medical University, Shanghai, China.
⁴ Department of Spine Surgery, Changhai Hospital affiliated to Navy Medical University, Shanghai, China.

Abstract

Background: The relationship between graft maturity on magnetic resonance imaging (MRI) and return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction is unclear.

Purpose: To compare signal-to-noise quotient (SNQ) values and ACL graft T2* (gradient echo) values between patients who did RTS and those who did not RTS (NRTS) after ACL reconstruction and to evaluate the predictive value of T2* mapping for RTS after ACL reconstruction.

Study design: Case-control study; Level of evidence, 3.

Methods: At a minimum of 9 months after arthroscopic single-bundle ACL reconstruction with autologous hamstring tendon graft, 82 patients underwent RTS assessment as well as MRI evaluation. The patients were classified into RTS (n = 53) and NRTS (n = 29) groups based on the results of the assessment. The SNQ values in the proximal, middle, and distal regions of the graft and the T2* values of the graft were measured on MRI. The correlation between T2* values and RTS was assessed using Spearman correlation analysis. Receiver operating characteristic curves were constructed to compare the diagnostic performance, and the optimal T2* cutoff value for detecting RTS was determined based on the maximum Youden index.

Results: At 9 months after ACL reconstruction, the proximal, middle, and mean SNQ values in the RTS group were significantly lower than those in the NRTS group (proximal: 17.15 ± 4.85 vs 19.55 ± 5.05, P = .038; middle: 13.45 ± 5.15 vs. 17.75 ± 5.75, P = .001; mean: 12.37 ± 2.74 vs 15.07 ± 3.32, P < .001). The T2* values were lower in the RTS group (14.92 ± 2.28 vs 17.69 ± 2.48; P < .001) and were correlated with RTS (r = -0.41; P = .02). The area under the curve of T2* was 0.79 (95% CI, 0.75-0.83), and the optimal cutoff value for T2* was 16.65, with a sensitivity and specificity for predicting failure to RTS of 67.9% and 88.2%, respectively.

Conclusion: Study findings indicated that the SNQs (mean, proximal, and middle) and the T2* values of the graft in the RTS group were significantly lower than those in NRTS group. A T2* value of 16.65 was calculated to predict patients who failed RTS tests with a sensitivity of 67.9% and specificity of 88.2%.

Keywords: T2*; anterior cruciate ligament reconstruction; graft; return to sports; signal-to-noise quotient.