Partial ACL tears augmented with distally inserted hamstring tendons and over-the-top fixation: an MRI evaluation

Area of Science:

• Orthopedic Surgery
• Radiology
• Sports Medicine

Background:

• Partial anterior cruciate ligament (ACL) tears often require surgical augmentation.
• Hamstring tendon grafts are commonly used for ACL reconstruction.
• Preserving the intact ACL bundle during augmentation is a key consideration.

Purpose of the Study:

• To evaluate the mid-term magnetic resonance imaging (MRI) appearance of partial ACL tear augmentation using quadrupled distally inserted hamstring grafts.
• To correlate MRI findings with clinical outcomes.

Main Methods:

• Twenty-eight patients with partial ACL tears underwent hamstring graft augmentation.
• Follow-up included clinical evaluation (IKDC score) and MRI at 15-40 months.
• MRI assessed graft appearance, continuity, intensity, tibial tunnel changes, and residual ACL.

Main Results:

• Excellent clinical results (25/28 patients) correlated with a continuous, low-intensity graft and a 30% decrease in tibial tunnel area.
• Fair clinical results (3/28 patients) were associated with non-visible/discontinuous grafts, high-intensity areas, and minimal tunnel area decrease (3%).
• The residual ACL was recognizable in 79% of cases, and tibial hamstring attachment appeared normal in 93%.

Conclusions:

• Mid-term MRI is valuable for assessing hamstring ACL grafts.
• Excellent clinical outcomes correlate with favorable MRI findings: decreased tunnel size and normal graft appearance.
• Poor outcomes are linked to non-visible/discontinuous grafts with high-intensity areas and cystic changes.