ACL hamstring grafts fixed using adjustable cortical suspension in both the femur and tibia demonstrate healing and integration on MRI at one year

Purpose To present the clinical outcomes and magnetic resonance imaging (MRI) analysis of adjustable cortical suspensory fixation for the femur and tibia in hamstring autograft anterior cruciate ligament reconstruction. Methods A cohort of 233 sequential patients was analysed for graft failure rate and subjective IKDC, Tegner and Lysholm scores. 144 validated 1-year MRIs assessed and correlated graft healing and tunnel widening. Results At mean follow-up of 28 months +/- 8.2 [median 26, range 12-49], the graft failure rate was 4.7%. Significant improvements were seen in all clinical scores (p < 0.001). MRI analysis showed 71% with fully integrated grafts in the tibia and 24% in the femur, with the remainder all showing greater than 50% integration. Graft signal was low and homogenous in 67% in the tibia, 29% in the intra-articular portion and 20% in the femur. One patient had greater than 50% high signal in the tibial graft and one in the intra-articular graft, all others demonstrated greater than 50% low signal. Both graft integration and signal were significantly better in the tibia than the femur (p < 0.01). Tunnel widening was 2.2 +/- 1.4 mm and 2.7 +/- 1.3 mm in the tibia and femur, respectively. Comparison of individual MRI appearances and overall clinical outcome at the same 12-month point demonstrated no consistent significant correlation. Conclusion Adjustable cortical suspensory fixation in both femoral and tibial tunnels provides good clinical outcomes and a low graft rupture rate. Grafts demonstrate healing with comparatively low tunnel widening. There was no consistent significant correlation between the appearances on MRI and clinical outcome.