✅ Knee MRI Mastery/Chap 2.ACL and PCL

(Fig 2-C.13) MRI Characteristics of Different Graft Type

MSK MRI 2024. 3. 3. 07:56

https://youtu.be/AfF9nLUkKco

https://youtu.be/uDgqFi3itg0

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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.
 

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