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Athymic Rat Model for Evaluation of Engineered Anterior Cruciate Ligament Grafts
Published on: March 26, 2015
Correlation between Phases of Graft Maturation and Graft Orientation with Functional Outcome in Single Bundle
Govind Kumar Gupta1, Ansu Soni1, Sudha Rani2
1Department of Orthopaedics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Background:
Graft maturation and orientation after single-bundle anterior cruciate ligament (ACL) reconstruction influence functional outcomes, but quantitative magnetic resonance imaging (MRI) correlations with validated clinical scores remain underexplored, particularly regarding surgical timing.
Objective:
To correlate 12-month MRI graft signal intensity ratio (SIR) and sagittal graft inclination with International Knee Documentation Committee (IKDC)/Lysholm scores after anatomic single-bundle ACL reconstruction, and assess injury-to-surgery interval effects.
Methodology:
Prospective study of 34 young adults (20-45 years) undergoing standardized arthroscopic ACL reconstruction at Rajendra Institute of Medical Sciences, Ranchi, a tertiary care center in Jharkhand, India. 12-month MRI measured SIR (vs. native ACL controls: 2.6-3.4, mean 2.95 ± 0.24) and sagittal inclination. Functional outcomes used IKDC/Lysholm scores at 6 and 12 months. Pearson correlations, t-tests, and multivariate regression analyzed relationships.
Results:
Graft SIR ranged 3.0-6.0 (mean 4.63 ± 0.71; P < 0.001 vs. native), with 42% ≤ 4.5 (near-native). SIR negatively correlated with 12-month IKDC (r = -0.62, P = 0.004) and Lysholm (r = -0.58, P = 0.007). Sagittal inclination (mean 52.6 ± 3.1°) showed no correlation. Early surgery (≤6 months) yielded lower SIR (4.25 ± 0.56 vs. 4.94 ± 0.68; P = 0.010) and higher IKDC (87.9 ± 4.4 vs. 79.8 ± 6.0; P = 0.012). Multivariate analysis confirmed SIR (β = -0.47, P = 0.009) and timing (β = -0.29, P = 0.038) independently predicted IKDC (R2 = 0.54).
Conclusion:
Lower 12-month graft SIR strongly predicts better functional outcomes after single-bundle ACL reconstruction. Earlier surgery enhances maturation; sagittal inclination within anatomical limits lacks impact. Quantitative MRI complements clinical assessment for rehabilitation planning.