MRI identifies five causes of complications from ACL reconstructive surgery

MRI has identified five possible causes of patient complications from anterior cruciate ligament (ACL) reconstructive surgery, according to a study performed at Emory University Hospital in Atlanta, GA, and Sahlgrenska University Hospital – Mölndal in Gothenburg, Sweden.

Sixteen patients with symptoms suggesting ACL reconstruction failure underwent MR imaging three weeks to three years following surgery to possibly determine the cause(s) of their complications.

"Persistent pain is the most consistent patient complaint. Others complain of instability, joint swelling and infection," said Claude Pierre-Jerome, MD, lead author of the study. The study found that there were five possible causes of reconstruction failure and patient complication: graft discontinuity (a tear or impingement in the graft, 5 knees), inappropriate position of the femoral and/or tibial tunnel (graft will not function properly without proper tunnel positioning, 2 knees) hardware failure (screws may not be in the right position, 3 knees), infection (1 knee) and intra-articular arthrofibrosis (affecting movement of the joint, 4 knees).

"These are only preliminary results for a much larger study," said Dr Pierre-Jerome.

"ACL reconstructive surgery is very common. In fact, ACL injuries account for every one in 3,000 injuries. We see many patients with a history of ACL surgery and it is our goal to make radiology more focused on the findings of pain in the knee," he said.

Dr Pierre-Jerome and his co-workers believe that "MRI can accurately detect the causes of surgical failure and persistent pain. MRI allows us to see all of the structures of the knee very well. If the graft is not normal, we can make a note of it and tell the surgeon right away that something is wrong," he said.

This study will be presented at the 2009 ARRS Annual Meeting in Boston, MA, on Wednesday, April 29.

(Source: 2009 ARRS Annual Meeting in Boston: American Roentgen Ray Society: April 2009)