Original Research

MRI evaluation of the anterior cruciate ligament graft post-arthroscopic reconstruction – A non-invasive comprehensive assessment

Sakshi Jeswani, Chetana R. Ratnaparkhi, Samir Dwidmuthe, Avinash Dhok, Mainak Roy
South African Journal of Radiology | Vol 29, No 1 | a3257 | DOI: https://doi.org/10.4102/sajr.v29i1.3257 | © 2025 Sakshi Jeswani, Chetana R. Ratnaparkhi, Samir Dwidmuthe, Avinash Dhok, Mainak Roy | This work is licensed under CC Attribution 4.0
Submitted: 17 July 2025 | Published: 05 November 2025

About the author(s)

Sakshi Jeswani, Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, India; and Department of Radiodiagnosis, Mahatma Gandhi Medical College and Hospital, Jaipur, India
Chetana R. Ratnaparkhi, Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, India
Samir Dwidmuthe, Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, India
Avinash Dhok, Department of Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, India
Mainak Roy, Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, India; and Department of Orthopaedics, All India Institute of Medical Sciences – Central Armed Police Forces Institute of Medical Sciences, New Delhi, India

Abstract

Background: Anterior Cruciate Ligament (ACL) reconstruction is a common orthopaedic procedure, the success of which is ultimately affected by the graft healing process. Quantification of graft healing can be performed non-invasively, using signal-intensity (SI) or signal noise quotient (SNQ) on MRI, however, the variable factors affecting graft healing are still being studied.
Objectives: To non-invasively evaluate the normal morphology of the ACL graft on MRI and assess factors affecting graft healing post-arthroscopic ACL reconstruction.
Method: A single-centre cross-sectional study was performed using MRI scans for assessment of the ACL graft at 6 months to 2 years post-surgery. Signal noise quotient was correlated with tibial tunnel diameter, femoral tunnel diameter, tibial tunnel location (antero-posterior and medio-lateral), femoral tunnel location (high-low and deep-shallow), graft bending angle (GBA) and notch volume.
Results: Twenty-four of 42 patients had normal grafts (mean ± standard deviation post-operative time: 10.15 ± 4.38 months). The SNQ levels were highest at the proximal part of the graft. Graft SNQ correlated positively with tibial (p = 0.020) and femoral (p ≤ 0.001) tunnel diameters, tibial tunnel location in the medio-lateral direction (P ≤ 0.001), femoral tunnel location in the high-low direction (p ≤ 0.001) and patients having complications. Graft SNQ correlated negatively with tibial tunnel location in the antero-posterior (AP) direction (p ≤ 0.001). Univariate analysis revealed a significant correlation between SNQ and tibial and femoral tunnel diameter, tibial tunnel location in both AP and medio-lateral directions, femoral tunnel location in high-low direction and patients having complications. Multivariate analysis showed the tibial tunnel location (medio-lateral) and the femoral tunnel location (high-low) as the significant independent factors.
Conclusion: Intraoperative factors, predominantly the positions of the tibial and femoral tunnels, are the major factors affecting graft healing.
Contribution: This study provides greater awareness regarding the factors affecting graft healing, helps establish MRI as an effective non-invasive post-operative imaging modality, and helps surgeons in providing a better individualised approach to surgery.


Keywords

MRI; ACL graft; signal noise quotient; tibial tunnel; femoral tunnel; signal intensity

Sustainable Development Goal

Goal 3: Good health and well-being

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