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1. Bone-Patellar-Tendon-Bone (BPTB) Autograft
✅ Early Postoperative Period (First Month)
- Signal Intensity: In the first month, BPTB autograft tendons typically show a low-intensity signal on both T1 and T2 sequences.
- This appearance is similar to the original patellar tendon, reflecting the relatively avascular nature of the donor structure.
✅ Remodeling Phase (Up to 16-18 Months)
- Changes: During the remodeling phase, the graft undergoes significant changes.
It is enveloped by synovial tissue and becomes vascularized, leading to an increased MRI signal. - Signal Intensity: The MRI signal intensity may increase for up to 16-18 months postoperatively.
✅ Long-Term Postoperative Period
- Final Appearance: After this period, the graft's signal stabilizes and closely resembles the original ACL's.
- Patellar Tendon Changes: A central defect in the patellar tendon, resulting from BPTB harvest, typically fills with scar tissue by 2 years postoperatively.
Persistent thinning at the harvest site and a thickened appearance of the surrounding patellar tendon are common thereafter.
2. Doubled Semitendinosus and Gracilis Tendon Graft
✅ Graft Composition
- Strands: This graft type is composed of four separate strands.
- MRI Appearance: Intermediate and even fluid signals between the strands can be a normal finding on T2-weighted sequences.
- Comparison: Such findings are considered abnormal for a BPTB graft, which consists of a single strand.
3. Allografts
✅ Maturation Process
- Comparison with Autografts: Allografts demonstrate a similar pattern of signal intensity changes as autografts but have a significantly longer maturation process.
- MRI Signal: It has been observed that allografts maintain a higher signal intensity compared to autografts for up to 2 years following ACL reconstruction.
"Visualizing MSK Radiology: A Practical Guide to Radiology Mastery"
© 2022 MSK MRI Jee Eun Lee All Rights Reserved.
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