ECR 2013 Rec: Dynamic contrast-enhanced imaging for detection of complications after double-bundle reconstruction of the anterior cruciate ligament #SS1810 #B0931

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B-0931 Dynamic contrast-enhanced imaging for detection of complications after double-bundle reconstruction of the anterior cruciate ligament

Y.-C. Lin, Y.-H. Juan, Y.-C. Cheung, W.-L. Yeh, C.-H. Chiu, C.-F. Tan, C.-M. Kuo | Monday, March 11, 14:00 – 15:30 / Room E1

Purpose: Double-bundle reconstruction with stump preservation has revolutionized the surgical treatment for anterior cruciate ligament (ACL) injury. However, poor revascularization at the osteoligamentous interface (OI) of the tibia tunnel remains a major cause of graft complications. In this study, we applied dynamic contrast-enhanced (CE) magnetic resonance imaging (MRI) to quantify the OI enhancement values of the tibia tunnels and ACL stump. We aimed to determine the relationship between graft complications and OI and stump enhancements.
Methods and Materials: From October 2011 to April 2012, 34 patients were enrolled in our study (mean postoperative duration, 7.3 months). All patients underwent one 1.5-T MRI study with the imaging pulse-sequence protocol of proton density-weighted imaging (WI), T2WI, pre-enhanced and post-enhanced T1WI, and dynamic CE MRI. Graft complications, including cystic degeneration and tear, were evaluated using pre-enhanced MRI, and peak enhancement (ePeak) values were acquired from a dynamic CE study. The receiver operating characteristic (ROC) analysis was used to obtain optimal cut-off values for complicated grafts.
Results: Our study included 28 patients (mean age, 25.5 years). Nine patients (32.1%) had cystic degeneration and 1 (3.6%) had complete posterolateral (PL) bundle tear. Mean ePeak percentages for graft with or without complications were 84.19%/127.69% for anterior–medial (AM) bundle, 107.54%/128.21% for PL bundle, and 171%/151.06% for stump, respectively. ROC analysis yielded the optimal ePeak cut-off values of 126 %, 104 %, and 35 % for AM bundle, PL bundle, and stump, respectively.
Conclusion: Graft complications were directly associated with higher tibial OI values but inversely associated with higher stump values.

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