Critical dialogue: Anterior cruciate ligament reconstruction: evolving surgical concepts and their radiological implications

Current practice and knowledgeAnterior cruciate ligament (ACL) injuries are among the most common ligamentous injuries of the knee [1-3].As surgical techniques continue to evolve, the role of the radiologist extends beyond simple confirmation of ACL injury, with growing emphasis on comprehensive MRI interpretation relevant to clinical assessment and surgical evaluation [4].ACL injury is primarily diagnosed through patient history and targeted physical examination, while MRI remains the most sensitive and specific imaging modality for confirmation [5][6][7].In tertiary musculoskeletal centers, comprehensive MRI interpretation is well established.However, an increasing number of patients undergo MRI at outside institutions.In such settings, technical limitations, suboptimal imaging parameters, and workflow constraints may limit comprehensive radiological assessment.In inconspicuous cases, additional images acquired in sagittal oblique (parallel to the lateral femoral condyle) and coronal-oblique (along the ACL axis, from the roof of the intercondylar notch) planes, or isotropic volumetric 3D images (≤ 2.5 mm; DESS, SPACE) may aid in comprehensive knee evaluation, which may not always be feasible [8].Nevertheless, even within practical limitations, radiology reports should aim to include as much clinically relevant information as reasonably achievable beyond isolated confirmation of ACL disruption.