Correlation between Phases of Graft Maturation and Graft Orientation with Functional Outcome in Single Bundle Anterior Cruciate Ligament Reconstruction

BACKGROUND: Graft maturation and orientation after single-bundle anterior cruciate ligament (ACL) reconstruction influence functional outcomes, but quantitative magnetic resonance imaging (MRI) correlations with validated clinical scores remain underexplored, particularly regarding surgical timing. OBJECTIVE: To correlate 12-month MRI graft signal intensity ratio (SIR) and sagittal graft inclination with International Knee Documentation Committee (IKDC)/Lysholm scores after anatomic single-bundle ACL reconstruction, and assess injury-to-surgery interval effects. METHODOLOGY: Prospective study of 34 young adults (20-45 years) undergoing standardized arthroscopic ACL reconstruction at Rajendra Institute of Medical Sciences, Ranchi, a tertiary care center in Jharkhand, India. 12-month MRI measured SIR (vs. native ACL controls: 2.6-3.4, mean 2.95 ± 0.24) and sagittal inclination. Functional outcomes used IKDC/Lysholm scores at 6 and 12 months. Pearson correlations, t-tests, and multivariate regression analyzed relationships. RESULTS: Graft SIR ranged 3.0-6.0 (mean 4.63 ± 0.71; P < 0.001 vs. native), with 42% ≤ 4.5 (near-native). SIR negatively correlated with 12-month IKDC (r = -0.62, P = 0.004) and Lysholm (r = -0.58, P = 0.007). Sagittal inclination (mean 52.6 ± 3.1°) showed no correlation. Early surgery (≤6 months) yielded lower SIR (4.25 ± 0.56 vs. 4.94 ± 0.68; P = 0.010) and higher IKDC (87.9 ± 4.4 vs. 79.8 ± 6.0; P = 0.012). Multivariate analysis confirmed SIR (β = -0.47, P = 0.009) and timing (β = -0.29, P = 0.038) independently predicted IKDC (R2 = 0.54). CONCLUSION: Lower 12-month graft SIR strongly predicts better functional outcomes after single-bundle ACL reconstruction. Earlier surgery enhances maturation; sagittal inclination within anatomical limits lacks impact. Quantitative MRI complements clinical assessment for rehabilitation planning.