Imaging Review of Knee Ligament Reconstructions Other than the Anterior Cruciate Ligament

Assessment of knee ligament reconstructions other than the anterior cruciate ligament is challenging due to limited data and continuously developing techniques. Imaging is vital to assessment, demonstrating expected postoperative findings, allowing detection of complications, and enabling differentiation of techniques from one another-information that is critical if revision is being contemplated. Stress radiography is useful for evaluating joint stability in the setting of ligament insufficiency. The three-dimensional and multiplanar reconstruction capabilities of CT are highly useful in multiligament reconstruction, allowing unhindered evaluation of the many intersecting bone tunnels. Susceptibility artifacts in MRI can be remedied by use of metal artifact reduction sequences. Each technique, graft, and choice of specific ligaments to reconstruct must be decided on a case-to-case basis. Anatomic reconstruction reproduces the native ligament's anatomy but is more technically complex. Nonanatomic reconstruction is easier to perform but potentially provides less stability. As for graft selection, an autograft weakens another knee stabilizer, but an allograft is more expensive and less readily available. The decision to perform a single-ligament versus combined-ligament reconstruction ultimately rests on the degree of instability and the desire to return to sport. In contrast to single-ligament reconstruction, combined-ligament procedures are at higher risk of postoperative stiffness, arthrofibrosis, and tunnel convergence. Renewed attention to repair along with improvements in patient selection and rehabilitation protocols may change the future of operative treatment of ligament injury, and along with it, radiologic appraisal and reporting. ^©RSNA, 2025 Supplemental material is available for this article.