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Correlation Between Knee Laxity and Graft Appearance on Magnetic Resonance Imaging After Double-Bundle Hamstring Graft Anterior Cruciate Ligament Reconstruction

Masaki Sonoda, MD, PhD^,*, Tsuguo Morikawa, MD, PhD, Kan Tsuchiya, MD, PhD and Hideshige Moriya, MD, PhD

From Orthopaedics and Sports Medicine, JFE Kawatetsu Hospital, Chiba, Japan, and the Department of Orthopaedics, Chiba University, Chiba, Japan

^* Address correspondence to Masaki Sonoda, MD, PhD, Orthopaedics and Sports Medicine, JFE Kawatetsu Hospital, 1-11-12 Minami-cho Chuo-ku, Chiba 260-0842, Japan (e-mail: msonoda{at}kch.chuo.chiba.jp).

Background: In recent years, double-bundle (anteromedial bundle [AMB], posterolateral bundle [PLB]) anterior cruciate ligament reconstruction has developed into an accepted practical surgical procedure; therefore, its efficacy needs to be established.

Hypothesis: Multiple-sliced 2-dimensional magnetic resonance imaging allows evaluation of each bundle separately. Both bundles are important for knee stability, and each bundle has a role in the prevention of knee instability. Knee laxity testing will correlate with the magnetic resonance imaging appearance of the individual graft bundles.

Study Design: Cohort study; Level of evidence, 2.

Methods: A total of 97 double-bundle anterior cruciate ligament reconstructions were evaluated 1 year after surgery, including side-to-side difference of KT-2000 arthrometer and pivot shift test. T2-weighted 2-dimensional magnetic resonance images were captured in the middle plane of each bundle to express magnetic resonance signals of each bundle. The magnetic resonance signals were divided into 3 grades: grade I, low-intensity signal; grade II, high-intensity signal within 50%; and grade III, high-intensity signal greater than 50%.

Results: Anterior laxity in AMB grade II (PLB I, 3.5 ± 1.7 mm; PLB II, 4.5 ± 1.9 mm) was significantly larger than in AMB grade I (PLB I, 1.9 ± 1.7 mm; PLB II, 2.1 ± 1.7 mm) with statistical difference (P = .025 in PLB I; P = .002 in PLB II). A positive rate in pivot shift test in PLB II (48%) was significantly larger than in PLB I (21%) with statistical difference (P = .031).

Conclusions: Varying magnetic resonance signals according to the bundle indicate role differences of each bundle in knee stability. These results imply that the AMB has a major role in preventing anterior translation of the tibia and the PLB has a major role in preventing anterolateral rotatory instability.

Key Words: anterior cruciate ligament (ACL) • double-bundle reconstruction • magnetic resonance imaging (MRI)