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Anterior Cruciate Ligament: Postoperative Imaging
Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR; Donna G. Blankenbaker, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Anterior cruciate ligament (ACL)
        • Definitions

          • Graft isometry
            • Refers to maintenance of constant length and tension of graft through normal ROM
          • Blumensaat line: slope of intercondylar notch roof in sagittal plane
          • Slope angle: sagittal graft angle, measured relative to Blumensaat line
          • Cyclops lesion
            • Focal synovial hypertrophy and fibrosis anterior to reconstructed ACL
            • "Hard" nodule: restricts terminal knee extension
            • "Soft" cyclopoid scar: less likely to cause motion restriction

        IMAGING

        • General Features

          • MR Findings

            • Imaging Recommendations

              PATHOLOGY

              • Gross Pathologic & Surgical Features

                CLINICAL ISSUES

                • Presentation

                  • Demographics

                    • Natural History & Prognosis

                      • Treatment

                        DIAGNOSTIC CHECKLIST

                        • Consider

                          • Image Interpretation Pearls

                            • Reporting Tips

                              Selected References

                              1. Garcia S et al: Anterior cruciate ligament re-tear and revision reconstruction in the skeletally immature athlete. Curr Rev Musculoskelet Med. 13(3):369-78, 2020
                              2. Somanathan A et al: Review of magnetic resonance imaging features of complications after anterior cruciate ligament reconstruction. Singapore Med J. 60(2):63-8, 2019
                              3. Daniels SP et al: Arthroscopic primary repair of the anterior cruciate ligament: what the radiologist needs to know. Skeletal Radiol. 47(5):619-29, 2018
                              4. Srinivasan R et al: Knee imaging following anterior cruciate ligament reconstruction: the surgeon's and radiologist's perspectives. Semin Musculoskelet Radiol. 22(4):386-97, 2018
                              5. Zappia M et al: Anterior cruciate ligament reconstruction: MR imaging findings. Musculoskelet Surg. 101(Suppl 1):23-35, 2017
                              6. Kiekara T et al: Tunnel communication and increased graft signal intensity on magnetic resonance imaging of double-bundle anterior cruciate ligament reconstruction. Arthroscopy. 30(12):1595-601, 2014
                              7. Ntoulia A et al: Evaluation with contrast-enhanced magnetic resonance imaging of the anterior cruciate ligament graft during its healing process: a two-year prospective study. Skeletal Radiol. 42(4):541-52, 2013
                              8. Ghazikhanian V et al: Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis. Skeletal Radiol. 41(11):1375-9, 2012
                              9. Kiekara T et al: MRI of double-bundle ACL reconstruction: evaluation of graft findings. Skeletal Radiol. 41(7):835-42, 2012
                              10. Naraghi AM et al: Anterior cruciate ligament reconstruction: MR imaging signs of anterior knee laxity in the presence of an intact graft. Radiology. 263(3):802-10, 2012
                              11. Bakhru P et al: MRI of broken bioabsorbable crosspin fixation in hamstring graft reconstruction of the anterior cruciate ligament. Skeletal Radiol. 40(6):737-43, 2011
                              12. Bencardino JT et al: MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics. 29(7):2115-26, 2009
                              13. Casagranda BU et al: Normal appearance and complications of double-bundle and selective-bundle anterior cruciate ligament reconstructions using optimal MRI techniques. AJR Am J Roentgenol. 2009 May;192(5):1407-15. Review. Erratum in: AJR Am J Roentgenol. 192(6):1454, 2009
                              14. Pritchett JW: Assisted reproduction of the anterior cruciate ligament. J Knee Surg. 22(4):325-30, 2009
                              15. Takeda Y et al: In vivo magnetic resonance imaging measurement of tibiofemoral relation with different knee flexion angles after single- and double-bundle anterior cruciate ligament reconstructions. Arthroscopy. 25(7):733-41, 2009
                              16. Lee GH et al: The incidence of acute patellar tendon harvest complications for anterior cruciate ligament reconstruction. Arthroscopy. 24(2):162-6, 2008
                              17. Pombo MW et al: Anatomic double-bundle anterior cruciate ligament reconstruction: where are we today? Arthroscopy. 24(10):1168-77, 2008
                              18. McCauley TR: MR imaging evaluation of the postoperative knee. Radiology. 234(1):53-61, 2005
                              19. Papakonstantinou O et al: Complications of anterior cruciate ligament reconstruction: MR imaging. Eur Radiol. 13(5):1106-17, 2003
                              20. Huang GS et al: Acute anterior cruciate ligament stump entrapment in anterior cruciate ligament tears: MR imaging appearance. Radiology. 225(2):537-40, 2002
                              21. Hodler J et al: The cruciate ligaments of the knee: correlation between MR appearance and gross and histologic findings in cadaveric specimens. AJR Am J Roentgenol. 159(2):357-60, 1992
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Diagnostic Checklist

                                    TERMINOLOGY

                                    • Abbreviations

                                      • Anterior cruciate ligament (ACL)
                                    • Definitions

                                      • Graft isometry
                                        • Refers to maintenance of constant length and tension of graft through normal ROM
                                      • Blumensaat line: slope of intercondylar notch roof in sagittal plane
                                      • Slope angle: sagittal graft angle, measured relative to Blumensaat line
                                      • Cyclops lesion
                                        • Focal synovial hypertrophy and fibrosis anterior to reconstructed ACL
                                        • "Hard" nodule: restricts terminal knee extension
                                        • "Soft" cyclopoid scar: less likely to cause motion restriction

                                    IMAGING

                                    • General Features

                                      • MR Findings

                                        • Imaging Recommendations

                                          PATHOLOGY

                                          • Gross Pathologic & Surgical Features

                                            CLINICAL ISSUES

                                            • Presentation

                                              • Demographics

                                                • Natural History & Prognosis

                                                  • Treatment

                                                    DIAGNOSTIC CHECKLIST

                                                    • Consider

                                                      • Image Interpretation Pearls

                                                        • Reporting Tips

                                                          Selected References

                                                          1. Garcia S et al: Anterior cruciate ligament re-tear and revision reconstruction in the skeletally immature athlete. Curr Rev Musculoskelet Med. 13(3):369-78, 2020
                                                          2. Somanathan A et al: Review of magnetic resonance imaging features of complications after anterior cruciate ligament reconstruction. Singapore Med J. 60(2):63-8, 2019
                                                          3. Daniels SP et al: Arthroscopic primary repair of the anterior cruciate ligament: what the radiologist needs to know. Skeletal Radiol. 47(5):619-29, 2018
                                                          4. Srinivasan R et al: Knee imaging following anterior cruciate ligament reconstruction: the surgeon's and radiologist's perspectives. Semin Musculoskelet Radiol. 22(4):386-97, 2018
                                                          5. Zappia M et al: Anterior cruciate ligament reconstruction: MR imaging findings. Musculoskelet Surg. 101(Suppl 1):23-35, 2017
                                                          6. Kiekara T et al: Tunnel communication and increased graft signal intensity on magnetic resonance imaging of double-bundle anterior cruciate ligament reconstruction. Arthroscopy. 30(12):1595-601, 2014
                                                          7. Ntoulia A et al: Evaluation with contrast-enhanced magnetic resonance imaging of the anterior cruciate ligament graft during its healing process: a two-year prospective study. Skeletal Radiol. 42(4):541-52, 2013
                                                          8. Ghazikhanian V et al: Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis. Skeletal Radiol. 41(11):1375-9, 2012
                                                          9. Kiekara T et al: MRI of double-bundle ACL reconstruction: evaluation of graft findings. Skeletal Radiol. 41(7):835-42, 2012
                                                          10. Naraghi AM et al: Anterior cruciate ligament reconstruction: MR imaging signs of anterior knee laxity in the presence of an intact graft. Radiology. 263(3):802-10, 2012
                                                          11. Bakhru P et al: MRI of broken bioabsorbable crosspin fixation in hamstring graft reconstruction of the anterior cruciate ligament. Skeletal Radiol. 40(6):737-43, 2011
                                                          12. Bencardino JT et al: MR imaging of complications of anterior cruciate ligament graft reconstruction. Radiographics. 29(7):2115-26, 2009
                                                          13. Casagranda BU et al: Normal appearance and complications of double-bundle and selective-bundle anterior cruciate ligament reconstructions using optimal MRI techniques. AJR Am J Roentgenol. 2009 May;192(5):1407-15. Review. Erratum in: AJR Am J Roentgenol. 192(6):1454, 2009
                                                          14. Pritchett JW: Assisted reproduction of the anterior cruciate ligament. J Knee Surg. 22(4):325-30, 2009
                                                          15. Takeda Y et al: In vivo magnetic resonance imaging measurement of tibiofemoral relation with different knee flexion angles after single- and double-bundle anterior cruciate ligament reconstructions. Arthroscopy. 25(7):733-41, 2009
                                                          16. Lee GH et al: The incidence of acute patellar tendon harvest complications for anterior cruciate ligament reconstruction. Arthroscopy. 24(2):162-6, 2008
                                                          17. Pombo MW et al: Anatomic double-bundle anterior cruciate ligament reconstruction: where are we today? Arthroscopy. 24(10):1168-77, 2008
                                                          18. McCauley TR: MR imaging evaluation of the postoperative knee. Radiology. 234(1):53-61, 2005
                                                          19. Papakonstantinou O et al: Complications of anterior cruciate ligament reconstruction: MR imaging. Eur Radiol. 13(5):1106-17, 2003
                                                          20. Huang GS et al: Acute anterior cruciate ligament stump entrapment in anterior cruciate ligament tears: MR imaging appearance. Radiology. 225(2):537-40, 2002
                                                          21. Hodler J et al: The cruciate ligaments of the knee: correlation between MR appearance and gross and histologic findings in cadaveric specimens. AJR Am J Roentgenol. 159(2):357-60, 1992