(Fig 2-C.12) ACL Graft Ligamentization

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MR Postoperative Appearance of Reconstructed ACL

1️⃣ Initial Imaging After Surgery:

• The graft typically exhibits low to intermediate signal intensity due to its avascular nature.

2️⃣ Intermediate Stage (4 to 8 Months After Reconstruction):

• Within this timeframe, intermediate signal intensity is often observed within grafts.
• This signal intensity decreases over time and usually resolves completely by 12 months post-surgery.
• The increased signal is attributed to graft revascularization and synovialization processes.

📌Tendon Graft "Ligamentization" Process:

• Following anterior cruciate ligament reconstruction (ACLR), the tendon graft undergoes "ligamentization."
• Reported lengths of this process vary from 6 to 48 months.

📌Association with Graft Rupture:

• Reassessment MRI may reveal higher signal intensity in the intact graft, characterized by a higher signal-noise quotient and heterogeneous hyperintensity.
• This heightened signal intensity is linked to an increased risk of subsequent graft rupture.
• Am J Sports Med. 2023 May;51(6):1466-1479

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