Return to Previous Levels of Performance Around 10 Months After Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft Does Not Delay Signal Intensity Reduction in a Graft: A Serial 3.0-T MRI Study.

Many athletes expect to return to previous levels of performance (RTP) within 12 months after anterior cruciate ligament (ACL) reconstruction (ACLR) while ACL graft remodeling takes from 6 to 48 months. Therefore, RTP might deteriorate the ACL graft remodeling process. The purpose of this study was to evaluate the changes of signal intensity in ACL graft and assess whether RTP affects ACL graft remodeling after ACLR using bone-patellar tendon-bone (BPTB) autograft with a serial 3.0-T magnetic resonance image (MRI) at 6, 12, and 24 months. It was hypothesized that signal intensity reduction in ACL graft on MRI might be delayed by RTP within 12 months after ACLR using BPTB autograft. Cross-sectional study; Level of evidence, 3. This retrospective cohort study consisted of 115 patients (48 male, 67 female) who underwent primary ACLR using BPTB autograft between 2018 and 2021, including 4 female patients with ACL graft rupture within 24 months. The signal-to-noise quotient (SNQ) values at intra-articular ACL graft on serial MRIs and the amount of change in SNQ value (1) from 6 to 12 months after ACLR (ΔSNQ 6-12) and (2) from 12 to 24 months after ACLR (ΔSNQ 12-24) were calculated. Patients were divided into 2 groups depending on whether patients were able to RTP (group A) or not (group B). To investigate the associated factors with ΔSNQ (6-12) and ΔSNQ (12-24), a fixed-effect multivariate logistic regression analysis was conducted with age, sex, body mass index (BMI), cartilage injury, postoperative Tegner score, and RTP as associated variables. Of 111 patients with ≥24 months follow-up, 83 patients (74.8%) were able to RTP within a mean time of 10.4 months (range, 6.5-18 months). The mean ± SD SNQ values (6 months, 1.21 ± 1.94; 12 months, 1.16 ± 2.38; 24 months, 1.42 ± 2.65) did not vary over time. Mean ± SD ΔSNQ (6-12) and ΔSNQ (12-24) were -0.05 ± 2.29 and 0.26 ± 1.83, respectively. There were no significant differences in the SNQ values and ΔSNQs between groups A and B. The multivariate logistic regression analysis showed that postoperative Tegner score and RTP were not associated with ΔSNQ while higher BMI increased ΔSNQ (6-12) (odds ratio, 1.147; 95% CI, 1.016-1.295; P = .03). RTP around 10 months after ACLR using BPTB autograft was not associated with SNQ reduction in ACL graft.