Comparative MRI Study Of Anterior Cruciate Ligament Reconstruction In Knee Joint Using 4-strand And 5-strand Semitendinosus And Gracilis Tendon Auto Graft

Background: Anterior cruciate ligament is a common injury,which occurs in about 250,000 people in United States.An injury to the ACL results in significant functional disability [1].In this sports medicine era ACL reconstruction plays a vital role for the patients quality life.It has been proved that torn ACL cannot heal with conservative management and repair alone.Accordingly,ACL reconstruction is considered as the standard surgical procedure for the treatment of ACL tear.MRI plays an important role in evaluating the integrity of ACL graft as well as in diagnosing the complication associated with ACL tear.Recurrent instability after primary ACL reconstruction has an incidence of 3% to 10%[27].One of the most etiologies of recurrent instability is graft failure.70% of injuries occur through non-contact mechanism.For a graft choice Hamstring tendon is preferred because of its biomechanical properties.The hamstring tendon auto graft has a greater ultimate tensile load,stiffness and cross sectional area than that of naive ACL.Objective: To evaluate the MRI findings in 40 Postoperative ACLreconstructed patients in 5-strand and 4-strand semitendinosus and gracilis tendon autograft and compare the qualitative differences in both the graft.Methods: Between January 2015 to December 2016,MRI findings of 40 posts ACL reconstruction patient were reviewed.The ACL reconstruction was grouped under two categories;Group A and Group B,Group A under 5-strand autograft including 20 patients whereas Group B under 4-strand autograft including 20 patients using hamstring and gracilis tendon.Evaluation of MRI findings includes signs of graft tear,graft intensity,graft signal,graft thinning,graft discontinuity,tunnel position and Posterior cruciate ligament(PCL)hyperbuckling.MRI examination was performed on the basic of Post-operative follow up for 1 months,3 months and six months.Our qualitative results were compared with both the grafts(5-strand and 4-strand).The significance values were calculated.Results: A total number of 40 patients were studied.In this study we divided in two groups,20 in each groups for 5-strand autograft and 4-strand autograft using semitendinosus and gracilis tendon for reconstruction.The mean age of Group A and Group B was 29.85 and 31.3 respectively irrespective of sex.The comparative difference in both the groups was in graft signal and diffuse graft intensity in which was follow up was done for up to 6 months.Group A and Group B patient has the significant difference in the MRI evaluation in graft intensity and graft signal but the others features seems normal in both the groups after evaluating the follow up MRI for 1 month,3 months and 6 months.Graft fiber continuity and full graft thickness was the most valuable primary sign in diagnosis of intact graft.Complete discontinuous graft was valuable in diagnosisof full-thickness tear.Focal graft thinning was valuable in diagnosis of partial tear in comparative study between the two groups.We obtain the significance U value i.e.p>0.05.Conclusion: Two groups of patients which we evaluated by using MRI varies no significant clinical difference after post ACL reconstruction either with5-strand or 4-strand semitendinosus and gracilis tendon autograft.Both strands of tendon can fully meet the ACL reconstruction needs.