Postoperatives Knie

The anterior cruciate ligament (ACL) is one of the most frequently injured ligaments of the knee. During the first month after surgery, MR signal intensity of ACL grafts is usually low on T1- and T2-weighted MRI, and thus is similar to normal patellar tendon, reflecting the relatively avascular nature of the grafts, noted lead author Dr. Ralph Gnannt, from the department of radiology at Zurich University Hospital, in a comprehensive education exhibit presented at the RSNA 2011 congress.

Over time, ACL grafts will undergo a phase of remodeling during which they get enveloped by synovial tissue with graft vascularization. This results in mild increased signal intensity on T1- and T2-weighted MRI during the next 12 to 18 months, after which the signal intensity characteristics approach those of native ACL.

 

 

If the tibial tunnel is located too far anteriorly, patients typically cannot fully extend the knee due to roof impingement. If tibial tunnels are positioned too far posteriorly or too vertically, persistent knee instability related to graft laxity is likely, he stated. The femoral tunnel should be located posterior to the intersection of the Blumensaat line and a line parallel to the posterior femoral cortex. The optimal angle of the ACL graft on coronal MRI should be less than 75° in relation to the horizontal.

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