Purpose To compare anterior cruciate ligament (ACL) graft maturation with other grafts in multiligament knee reconstruction at 1 year postoperatively while also evaluating its relationship with clinical laxity, identifying factors influencing graft maturation, and analyzing tunnel widening. Methods This retrospective study included patients between October 2019 and April 2023, who underwent multiligament knee reconstruction using autografts and a 1‐year clinical and magnetic resonance imaging follow‐up. The injury was classified according to Schenck's classification. The autografts used were hamstrings and/or bone tendon grafts, as appropriate to the injury pattern. A 1‐year postoperative 3 Tesla magnetic resonance imaging was used for the assessment of graft maturation according to Howell's score (1‐4) and tunnel widening. Maturation status was assessed for each ligament and compared with ACL graft maturation. Correlations between graft maturation and clinical laxity was analyzed. Tunnel widening was analyzed for each reconstructed ligament. The impact of different graft fixation systems on maturation was also evaluated. Results A total of 72 patients were included, with 215 ligaments reconstructed. Howell and I scores were found in 85% of ACL, 37.5% of posterior cruciate ligament, 97% of medial collateral ligament, 92% of posterior oblique ligament, 100% of lateral collateral ligament, and 81% of popliteal tendon grafts. ACL graft maturation was greater than posterior cruciate ligament maturation ( P < .001). Medial collateral ligament and lateral collateral ligament grafts maturation was greater than ACL grafts ( P < .024 and P < .033, respectively). Lack of graft maturation correlated with clinical laxity, particularly in the posterior cruciate ligament. Tunnel widening was observed in all reconstructions ( P < .05). Graft maturation appeared superior with double screw fixation compared with double cortical suspensory fixation system ( P < .001). Conclusions One year after multiligament knee reconstruction, graft maturation varies depending on the reconstructed ligament. The posterior cruciate ligament shows delayed maturation compared with the ACL, while extra‐articular grafts exhibit better maturation. Level of Evidence Level III, retrospective comparative study based on a prospective cohort.
Vermorel et al. (Sun,) studied this question.