Serial magnetic resonance imaging study of posterior cruciate ligament reconstruction or augmentation using hamstring tendons - 01/10/14

Doi : 10.1016/j.otsr.2014.06.018

E. Fujimoto ^a,^⁎ , Y. Sasashige ^a, Y. Masuda ^a, Y. Tsuchida ^a,^b, T. Hisatome ^a, K. Kashiwagi ^a, H. Sasaki ^a, Y. Touten ^a, H. Kazusa ^a, A. Eguchi ^a, Y. Nagata ^a
^a Department of Orthopedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima 737-0193, Japan
^b Department of Radiology, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima 737-0193, Japan

^⁎Corresponding author. Department of Orthopedic Surgery, Chugoku Rousai Hospital, 1-5-1 Hirotagaya, Kure, Hiroshima 737-0193, Japan. Tel.: +81 82 37 27 171; fax: +81 82 37 40 371.

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Abstract

Purpose

The purpose of this study was to analyze serial changes in the magnetic resonance imaging (MRI) signals of autograft hamstrings single bundle posterior cruciate ligament (PCL) reconstruction and the effects of remnant preservation (augmentation).

Material and methods

Twenty-two isolated PCL injuries were arthroscopically reconstructed or augmented with hamstring tendons. MRI scans were obtained at 3, 6, and 12 months, and prior to the second-look arthroscopy (average 20.7 months). The patients were divided into 2 groups by remnant preservation: five PCL reconstructions after PCL remnant resection (Group Rec) (23%), and 17 reconstructions preserving the remnant (Group Aug) (77%). The 22 patients were also divided in two groups depending on the location of the PCL tear. There were 9 knees with proximal tear (Type P) (41%) and 13 knees with distal tear (Type D) (59%). The signal intensity and fiber continuity of 4 zones (proximal, middle, distal intra-articular and tibial tunnel zones) were evaluated by the Mariani score.

Results

The average MRI evaluation score gradually increased from 6 months through the final MRI. The intra-articular part of the graft exhibited slower maturation (12 months – final scan) as compared with the tibial tunnel (6–12 months). The distal zone underwent better maturation than the proximal or middle zones at all points. In the proximal zone, the score for Group Aug was significantly higher than Group Rec. In the proximal zone, the Type D score with a proximally-preserved remnant was significantly higher than Type P without a proximal remnant.

Conclusions

The hamstring tendons require more than 1 year to achieve low-signal intensity. PCL remnant has a beneficial effect on the maturation of the hamstring graft.