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Related Experiment Video

Updated: May 10, 2026

Athymic Rat Model for Evaluation of Engineered Anterior Cruciate Ligament Grafts
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Radiologic maturation and tunnel changes after all-inside versus standard hamstring ACL reconstruction: a prospective

Alessandro Carrozzo1, Edoardo Monaco2, Nicola Carlo Bianco3

  • 1Dipartimento di Scienze della Vita, Della Salute e delle Professioni Sanitarie, Link Campus University, Rome, Italy.

La Radiologia Medica
|February 21, 2026
PubMed
Summary
This summary is machine-generated.

All-inside anterior cruciate ligament (ACL) reconstruction using quadrupled semitendinosus (ST4) grafts showed similar graft maturation and clinical outcomes compared to doubled semitendinosus-gracilis (DSTG) grafts. However, ST4 grafts resulted in significantly less tibial tunnel widening.

Keywords:
ACL reconstructionAll-insideGraft maturationMRISignal-to-noise quotientTunnel widening

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Radiology

Background:

  • Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure.
  • Graft choice and surgical technique significantly impact outcomes.
  • Assessing graft maturation and tunnel healing is crucial for long-term success.

Purpose of the Study:

  • To compare MRI-based graft maturation and tibial tunnel healing between all-inside quadrupled semitendinosus (AI-ST4) and standard doubled semitendinosus-gracilis (DSTG) ACL reconstruction techniques.
  • To evaluate mid-term clinical outcomes and patient-reported outcome measures (PROMs) for both techniques.

Main Methods:

  • A single-center prospective comparative cohort study with sequential, non-randomized allocation.
  • Forty patients (20 per group) underwent ACL reconstruction with either AI-ST4 or DSTG.
  • Primary endpoints included MRI-assessed graft signal-to-noise quotient (SNQ) and tibial tunnel cross-sectional area (CSA) at 12 months, with clinical follow-up at 24 months.

Main Results:

  • Graft maturation (SNQ) was comparable between the AI-ST4 and DSTG groups at 12 months.
  • Tibial tunnel widening was significantly lower in the AI-ST4 group (45.5%) compared to the DSTG group (106.7%) (P=.02).
  • Clinical outcomes, PROMs, and laxity were similar between the groups at 24 months.

Conclusions:

  • Both AI-ST4 and DSTG techniques yield comparable graft maturation and mid-term clinical outcomes for ACL reconstruction.
  • The AI-ST4 technique demonstrates a significant advantage in reducing tibial tunnel widening compared to the DSTG technique.
  • While imaging metrics showed differences in tunnel healing, these did not translate to functional superiority at the mid-term follow-up.