No Difference in Graft Signal Intensity on Magnetic Resonance Imaging or Clinical Outcome Between Anterior Cruciate Ligament Reconstruction With and Without Suture Augmentation.

Purpose: To evaluate the safety of anterior cruciate ligament reconstruction (ACLR) with suture augmentation (SA) through clinical evaluations, monitoring of complications, and evaluation of early graft remodeling using magnetic resonance imaging (MRI).

Methods: Data of participants who underwent anatomic double-bundle ACLR using hamstring tendon autografts, with a minimum 2-year follow-up, were retrospectively reviewed. Participants undergoing ACLR with SA were propensity-matched with those without SA. Postoperative clinical evaluations were recorded, including Lysholm Knee Scoring Scale, Tegner activity score, International Knee Documentation Committee (IKDC) evaluation scores, KT-1000 side-to-side difference for knee stability at a 2-year follow-up, and complications. The minimal clinically important difference (MCID) was calculated for IKDC scores. The anteromedial bundle graft was categorized into distal, middle, and proximal regions on the 6-month and 1-year postoperative MRIs. The signal-to-noise quotient (SNQ) of each region of interest was calculated to evaluate the graft signal intensity, which was compared between the 2 groups using Welch's t test.

Results: Fifty-three participants were included in each group. No significant differences were observed between the non-SA and SA groups in the Lysholm scores (96.6 ± 6.2 and 95.3 ± 5.8, respectively; P = .25), Tegner activity scores (4.8 ± 1.4 and 5.0 ± 1.3, respectively; P = .49), IKDC scores (90.4 ± 10.8 and 87.1 ± 12.9, respectively; P = .15), percentage of patients meeting the MCID (94.3% and 83.0%, respectively; P = .12), or postoperative KT-1000 side-to-side difference (0.9 ± 1.2 and 0.7 ± 1.8 mm, respectively; P = .56). One (1.8%) and 2 (3.7%) cases of retears occurred in the non-SA and SA groups, respectively; no other complications occurred. The postoperative SNQ measurements revealed no significant differences in signal changes in all regions of the grafts between the 2 groups.

Conclusions: This study confirmed no difference in graft signal intensity on MRI or clinical outcome between ACLR with and without SA at the 2-year follow-up.

Level of evidence: Level III, retrospective, comparative study.