PCL graft ligamentization is the process of remodeling and revascularization that a tendon graft undergoes after being used for posterior cruciate ligament (PCL) reconstruction surgery. This process can be divided into three phases:
1.Early phase (0-3 months):
- The graft is avascular (no blood supply)
- It appears hypointense (dark) on all MRI sequences, similar to the donor tendon
2.Ligamentization phase (4-8 months):
- The graft undergoes remodeling and resynovialization (formation of a new synovial lining)
- High signal intensity may appear on T2-weighted MRI, but should be lower than fluid signal
- Fiber continuity must be observed, and this should not be mistaken for a tear or impingement
3. Maturation phase (1-2 years):
- The graft appearance should become similar to the native PCL
- It appears hypointense on all MRI sequences
During the ligamentization phase, the high signal intensity on MRI is a normal finding and should not be interpreted as a tear or impingement, as long as fiber continuity is maintained, and the signal is lower than fluid signal.
Skeletal Radiol. 2014 Dec;43(12):1659-68.
"Visualizing MSK Radiology: A Practical Guide to Radiology Mastery" © 2022 MSK MRI Jee Eun Lee All Rights Reserved. No unauthorized reproduction, redistribution, or use for AI training. #pcl, #pclinjury, #PCLreconstruction, #PCLsurgery, #Ligamentization
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