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      Magnetic resonance imaging after anterior cruciate ligament reconstruction: A practical guide

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          Abstract

          Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopedic procedures performed worldwide. In this regard, magnetic resonance imaging (MRI) represents a useful pre-operative tool to confirm a disruption of the ACL and to assess for potential associated injuries. However, MRI is also valuable post-operatively, as it is able to identify, in a non-invasive way, a number of aspects and situations that could suggest potential problems to clinicians. Graft signal and integrity, correct tunnel placement, tunnel widening, and problems with fixation devices or the donor site could all compromise the surgical outcomes and potentially predict the failure of the ACL reconstruction. Furthermore, several anatomical features of the knee could be associated to worst outcomes or higher risk of failure. This review provides a practical guide for the clinician to evaluate the post-surgical ACL through MRI, and to analyze all the parameters and features directly or indirectly related to ACL reconstruction, in order to assess for normal or pathologic conditions.

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          Most cited references47

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          Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient.

          An injury to the anterior cruciate ligament (ACL) is a multifactorial event influenced by intrinsic and extrinsic risk factors. Recently, the geometry of the proximal tibia has come under focus as a possible risk factor for an ACL injury.
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            Long-term failure of anterior cruciate ligament reconstruction.

            The aim of this study was to review and describe the cumulative incidence of anterior cruciate ligament (ACL) graft rupture and/or clinical objective failures at greater than 10 years after ACL reconstruction.
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              Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction

              Purpose A summary is provided on the existing knowledge about the specific healing phases of the intra-articular hamstring tendon graft used for ACL reconstruction. Differences between human and animal in vivo studies are explained, and implications for the postoperative time period are laid out. Methods A systematic review of the existing literature was performed on the topic of tendon remodelling of hamstring grafts in ACL reconstruction using Medline database. Publications between 1982 and 2012 were included. Special focus was directed on in vivo human and animal studies analysing intra-articular free tendon graft remodelling. Results Animal and human in vitro and vivo researches have demonstrated three characteristic stages of graft healing after ACL reconstruction: an early graft healing phase with central graft necrosis and hypocellularity and no detectable revascularization of the graft tissue, followed by a phase of proliferation, the time of most intensive remodelling and revascularization and finally, a ligamentization phase with characteristic restructuring of the graft towards the properties of the intact ACL. However, a full restoration of either the biological or biomechanical properties of the intact ACL is not achieved. Conclusion Significant knowledge on human cruciate ligament remodelling has been added in the understanding of the processes during the course of graft healing. Most importantly, the remodelling process in humans is prolonged compared to animal studies. While today´s rehabilitation protocols are often extrapolated from findings of animal in vivo healing studies, current findings of human in vivo healing studies might require new post-operative regimens following hamstring ACL reconstruction.
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                Author and article information

                Journal
                World J Orthop
                WJO
                World Journal of Orthopedics
                Baishideng Publishing Group Inc
                2218-5836
                18 October 2016
                18 October 2016
                : 7
                : 10
                : 638-649
                Affiliations
                Alberto Grassi, Cecilia Signorelli, Giuseppe Carbone, Andy Tchonang Wakam, Gian Andrea Lucidi, Stefano Zaffagnini, Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
                James R Bailey, Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University Medical Center, Durham, NC 27710, United States
                Stefano Zaffagnini, Unita’ Operativa di Ortopedia, Dipartimento Rizzoli-Sicilia, 90011 Bagheria, Italy
                Author notes

                Author contributions: Grassi A performed the majority of the writing; Signorelli C, Carbone G and Lucidi GA prepared the figures and tables; Tchonag Wakam A assisted in writing the paper; Zaffagnini S coordinated the writing of the paper and performed critical review; Bailey JR performed language correction and critical review of the contents.

                Correspondence to: Alberto Grassi, MD, Laboratorio di Biomeccanica ed Innovazione Teconologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy. alberto.grassi3@ 123456studio.unibo.it

                Telephone: +39-05-16366507

                Article
                jWJO.v7.i10.pg638
                10.5312/wjo.v7.i10.638
                5065670
                27795945
                b41fe4af-b7aa-4fec-880a-8d5176aaf6ed
                ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 26 February 2016
                : 22 June 2016
                : 11 August 2016
                Categories
                Review

                anterior cruciate ligament reconstruction,magnetic resonance imaging,graft,tunnel,failures,complications,anatomic

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