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a. MR Imaging of Complications Following Anterior Cruciate Ligament Graft Reconstruction

b. Department of Radiology, NYU Hospital for Joint Diseases

c. Jenny T. Bencardino, MD1, Marina I. Feldman, M.D., MBA 2,Javier Beltran, M.D. 3, M.D., Donald J. Rose, M.D4.

1 Jenny T. Bencardino, M.D., Associate Professor of Radiology
2 Javier Beltran, M.D., Clinical Professor of Radiology MountSinai School of Medicine, Chairman of Radiology Maimonides Medical Center, Brooklyn, NY
3 Marina I. Feldman, M.D, PGY4 Radiology Resident, Maimonides Medical Center, Brooklyn, NY
4 Donald J. Rose, M.D., Associate Professor of Orthopedic Surgery, NYU Hospital for Joint Diseases
d. No grant funding

e. Space number: LL-MK3271-L RSNA 2008

Corresponding Author:
Jenny T. Bencardino, M.D.Director of Musculoskeletal MRI
Associate Professor of Radiology
Department of Radiology
NYU Hospital for Joint Diseases
301 East 17th Street Sixth Floor
New York, NY 10003
Tel: 212-598-6373
Fax: 212-5986125

Acknowledgements: The authors would like to thank Dr. Salvador Beltran for his work as the medical illustrator of the manuscript and Martha Helmers, Supervisorof the Photo Radiology Unit at the Department of Radiology, NYU Langone Medical Center.

MR Imaging of Complications following Anterior Cruciate Ligament Graft Reconstruction

MR Imaging of Complications following Anterior Cruciate Ligament Graft Reconstruction


The purpose of this article is to review and illustrate the postoperative complications of anterior cruciate ligamentgraft reconstruction using both bone-patellar tendon-bone and hamstring grafts. The complications here presented were collected by two experienced musculoskeletal
radiologists following retrospective review of 100 non-contrast enhanced MR examinations of the knee obtained after ACL graft reconstruction procedures.

Conclusion/Summary: After reviewing this manuscript, the reader will befamiliarized with the MR appearance and associated findings of anterior cruciate ligament graft complications including roof impingement, partial and complete ACL graft tears, arthrofibrosis, tunnel synovial cysts, iliotibial band friction syndrome, hardware loosening and graft infection.

MR Imaging of Complications following Anterior Cruciate Ligament Graft Reconstruction


During thepast three decades, graft reconstruction of the anterior cruciate ligament (ACL) has become an accepted treatment for symptomatic ACL deficiency 1, 2. The goal of surgery is to prevent joint instability, which may cause and/or further damage the articular cartilage and menisci. Advances in reconstructive techniques and rehabilitation have led to significantly improved results. Nevertheless, ACLreconstruction failure rates remain high (10-25%) 3. Failure is defined as pathological laxity of the reconstructed ACL. Other complications following ACL reconstruction include roof impingement, recurrent knee trauma with graft tearing, postoperative stiffness, tunnel widening due to cyst formation, iliotibial band friction syndrome, hardware failure and infection. Magnetic Resonance Imaging (MRI)is the preferred advanced imaging modality for the evaluation of symptomatic ACL graft reconstructions 4, 5.

Normal ACL graft reconstruction

Anterior cruciate ligament graft choice remains controversial6. The most commonly employed grafts have included bone-patellar tendon-bone and hamstring autografts. The use of the middle third of the patellar tendon with bone plugs attached to eachend have been considered the historical “gold standard” for ACL graft reconstruction due to its inherent strength and stiffness (Fig. 1). However, subsequent patellar abnormalities and anterior knee pain are relatively frequent complications. A four strand hamstring graft is typically made of tendon segments removed from the semitendinosus and/or gracilis. The tendon segments are folded and...
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