Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) is increasingly performed in children and adolescents, yet mid- to long-term graft ligamentization remains poorly understood. Purpose: To characterize the magnetic resonance imaging (MRI) evolution of ACL grafts in pediatric patients between 2 and 5 years postoperatively. Study Design: Case series; Level of evidence, 4. Methods: The authors included 50 pediatric patients undergoing transphyseal ACLR with a semitendinosus tendon autograft folded in 4 without additional lateral extra-articular tenodesis to evaluate the evolution of ACL graft ligamentization over 5 years using quantitative (signal-to-noise quotient, SNQ) and qualitative (Howell grading) MRI criteria. The SNQ was measured in intra-articular and intra-tibial graft regions. Tibial tunnel widening (TTW) and its relation to graft signal were also assessed. MRI scans were performed at 6, 12, 24, and 60 months postoperatively. Results: Sixteen patients completed a 60-month follow-up. The median intra-articular SNQ peaked at 12 months, decreased by 24 months (median, 3), and finally stabilized, with no significant change at 60 months (median, 2.8; P = .999). Similar trends were observed for intra-tibial SNQ with no significant difference between 24 and 60 months ( P = .09). SNQ scores were compared using Wilcoxon signed-rank tests. Howell grading improved mainly within the first 24 months and remained stable thereafter, with Grade 1 or 2 in most grafts at final follow-up. TTW peaked at 6 months and gradually decreased. Conclusion: ACL graft ligamentization progresses primarily in the late first 2 years, followed by a subsequent plateau up to 5 years postoperatively.
Pesters et al. (Mon,) studied this question.
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