Biomedical subjects

P P Mariani

Publications and source records attributed to P P Mariani.

At least 19 recordsLinked to original sources

PubMed2006

Magnetic resonance imaging of posterior cruciate ligament injuries: a new classification of traumatic tears.

PURPOSE: The aim of our study was to propose a new classification of acute posterior ligament (PCL) injuries based on magnetic resonance imaging (MRI). MATERIALS AND METHODS: Using MRI, we reviewed 220 patients presenting an acute posterior ligament injury. The MRI exam was performed on a 0.2-Tesla (T) magnet and a 1.5-T magnet using T1-weighted spin echo (SE), T2-weighted SE and fat-suppression scans [short-tau inversion recovery (STIR)] in axial, sagittal and coronal planes. In no case was paramagnetic contrast agent injected. RESULTS: Twenty-five per cent of patients were identified as having type I lesions and another 30% as having type II lesions according to the Gross classification. Out of 77 patients, 35% of the whole sample, 37 had a tear of the posteromedial fascicle (type II lesion), and the remaining 40 had anterolateral fascicle tears (type III). In 10% of cases, the ligaments appeared completely interrupted, and these were classified as type IV lesions. CONCLUSIONS: T1-weighted SE sequences need to be integrated with T2-weighted and STIR sequences to detect the real extent of the remaining fascicle. The MRI exam could thus be able to provide a qualitative evaluation of PCL injuries and establish how the injury compromises joint stability.

Adolescent↗

PubMed2006

Total knee replacement: prevention of deep-vein thrombosis using pharmacological (low-molecular-weight heparin) and mechanical (intermittent foot sole pump system) combined prophylaxis. Preliminary results.

AIM: The aim of this study was to determine the role of combined mechanical and pharmacological prophylaxis in the prevention of deep venous thrombosis (DVT) after total knee replacement (TKR). DESIGN: prospective case series study. METHODS: Between October 2002 and June 2003, 38 total knee procedures were carried out on 34 patients (4 patients had bilateral TKR). To exclude the presence of a concomitant DVT echo-color-flow of the legs was performed between 2 and 1 week prior to surgery, in the postoperative period (before discharging) and 30 days after surgery. Patients received one daily subcutaneous injection of nadroparin calcium (dosage adapted to body-weight). An intermittent foot sole pump (IFSP) was applied in the recovery room postoperatively, in both feet for about 5 h a day and all night long, and continued at home until the 15(th) day. RESULTS: No major perioperative or rehabilitation phase-related complications were observed (2 patients required manual drainage of blood clots from the wound). The incidence of DVT was 7.9% (3 cases). In one of these cases we observed a previous DVT so it was classified as rethrombosis. All were successfully treated with therapeutic introduced low molecular weight heparin (LMWH) therapy. No pulmonary embolism or deaths associated with the use of LMWH or IFSP were observed. CONCLUSIONS: In our experience the combined prophylaxis with nadroparin calcium and IFSP significantly reduced the incidence of DVT.

Aged↗

PubMed2005

Intentional lateral epidural catheter placement for anterior cruciate ligament reconstruction.

BACKGROUND: Unilateral epidural block might constitute a clinical option in lower limb orthopedic surgery. METHODS: Seventy-five patients undergoing anterior cruciate ligament reconstruction (ACLR) were randomized to either a laterally directed epidural catheter (IUEC, n = 40) or a classic midline catheter (CMEC, n = 35). Paresthesia encountered during catheter insertion was registered. The start dose of the anesthetic mixture clonidine 60 microg (0.4 ml), sufentanil 15 microg (0.3 ml) and ropivacaine 10 mg ml(-1)(10.3 ml) in 11 ml of total volume) was set at 5 ml and was increased by 2 ml if anesthesia was inadequate after assessment for sensory blockade to cold and pin-prick. Data were registered intra- and postoperatively regarding pain scores as well as motor block, hemodynamic parameters, adverse effects and need for supplemental analgesia other than a continuous postoperative epidural infusion. RESULTS: In the IUEC group 80% of patients reported a light paresthesia of the affected side during catheter insertion, whereas 71% of patients in the CMEC group reported no paresthesia at all. The amount of anesthetic used to establish surgical anesthesia was lower in the IUEC group (6.2 +/- 0.8 vs. 8 +/- 1.9 ml, P < 0.001). Motor block (Bromage score) of the unaffected side was significantly lower in the IUEC group (P < 0.001). Pain intensity scores, hemodynamic parameters, and supplemental analgesia given were similar between the two groups except for VAS scores at 12 h postoperatively, which were higher in the CMEC group (P < 0.01). Urinary retention was significantly more frequent in the CMEC group (19/35 vs. 5/40, P < 0.001). CONCLUSION: These results suggest that the IUEC technique is a feasible and efficient method for providing anesthesia and analgesia for ACLR and is associated with a lower consume of anesthetics, less motor block and a reduced incidence of urinary retention.

Adolescent↗

PubMed2004

Low-intensity pulsed ultrasound in the conservative treatment of pseudoarthrosis.

AIM: The management of pseudarthrosis remains a challenge. Several in vivo animal and controlled clinical studies have demonstrated that low-intensity pulsed ultrasound can influence fracture healing. METHODS: A prospective longitudinal design was used. Fifteen patients (12 males and 3 females; mean age 35.5+/-12.9, range 18 to 60), all amateur athletes, under treatment for pseudarthrosis at different sites (average fracture age: of 336.6+/-60.1 days) were treated with a single 20 min daily application of low-intensity pulsed ultrasound (frequency 1.5 MHz and intensity 30 mW/cm2). All patients underwent clinical examination and plain radiography at the beginning of treatment and were followed up clinically and radiographically at 4, 8, 12, 16, 20 and 24 weeks until the fracture healed. RESULTS: All fractures healed with a mean healing time of 94.7+/-43.8 days. CONCLUSION: Low-intensity pulsed ultrasound is effective in the management of long standing fracture non-unions. Prospective randomized studies are needed to confirm the value of this modality of treatment.

Adult↗

PubMed2002

Rectal washout with cytotoxic solution can be extended to the whole colon.

BACKGROUND: Rectal irrigation with a cytotoxic agent does not kill viable intraluminal cancer cells proximal to the primary tumour. To prevent implantation of these cells at the time of restorative proctectomy, the feasibility of retrograde whole-colon irrigation just before surgery was explored. METHODS: The cytotoxic efficacy of different combinations of povidone-iodine (PVPI) and Gastrografin was tested with the trypan blue exclusion test on a human colon carcinoma cell line (SW620) in vitro. Subsequently, a retrograde whole-colon lavage with PVPI 5 per cent and Gastrografin 12 per cent was performed in 14 euthyroid, non-allergic patients with colorectal cancer using a colostomy irrigation set. Thyroid function and mucosal damage were assessed. RESULTS: It took 2 min and approximately 1 litre of infused solution to reach the caecum in all patients. The solution was 100 per cent tumoricidal in vitro and remained so after colonic irrigation. Total serum tri-iodothyronine (T3) levels decreased and those of reverse T3 increased, but normalized after 1 week. Superficial epithelial desquamation was observed shortly after irrigation; however, complete restoration occurred within 7 days. CONCLUSION: A rectal washout can easily be extended to a retrograde irrigation of the whole colon in elective colorectal cancer surgery. This may help to prevent anastomotic and local recurrence due to implantation of viable exfoliated tumour cells.

Adult↗

PubMed2001

C-reactive protein and erythrocyte sedimentation rate changes following arthroscopically assisted anterior cruciate ligament reconstruction.

We studied changes in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to establish normal values after uncomplicated anterior cruciate ligament (ACL) reconstruction. The levels of CRP and ESR were determined by serial measurements in 45 consecutively treated patients. Blood samples were collected before surgery and on postoperative days 1, 3, 7, 15, and 30. Both ESR and CRP showed a marked increase postoperatively, peaking between the 3rd and 7th postoperative days, the latter showing a faster return to normal ( P=0.286). These data show that CRP can be used as a more accurate predictor than ESR of postoperative complications if the blood level remains elevated or unexpectedly rises.

Adult↗

PubMed2001

Postoperative bleeding following notchplasty in anterior cruciate ligament reconstruction: thermal radio frequency versus powered instrumentation.

This study compared postoperative bleeding during anterior cruciate ligament (ACL) reconstruction following notchplasty by power instrumentation with that following radiofrequency. Between January 1998 and April 1998 we prospectively divided 24 consecutive patients undergoing arthroscopic ACL reconstruction with bone-patellar tendon-bone autograft into two groups. Notchplasty was performed by powered instrumentation in group A (n=12) and by radiofrequency in group B (n=12). Two Redi-Vac suction drains were placed, one intra-articularly and the other subcutaneously at the harvest site and tibial tunnel. All drains were removed 48 h postoperatively. The first drainage measurement (end of surgery, 6 a.m. postoperative day 1) showed average total bleeding of 124.16 cc in group A and 65.41 cc in group B (P<0.001); per hour this was 10.21 cc in group A and 5.49 cc in group B (P<0.001). The second drainage measurement (6 a.m. postoperative day 2) showed average total bleeding of 44.55 cc in group A and 17.78 cc in group B (P<0.01); per hour this was 1.85 cc in group A and 0.74 cc in group B (P<0.001). Radiofrequency technology can be used when performing intercondylar notchplasty in ACL reconstruction. As a result of this technique postoperative intra-articular bleeding was significantly reduced.

Adolescent↗

PubMed2001

Pseudoaneurysm as a complication of ankle arthroscopy.

We describe a case of pseudoaneurysm of the anterior tibial artery as a complication after arthroscopic ankle synovectomy, in which standard anterolateral and anteromedial portals were used. Pseudoaneurysm has been previously reported as a complication in ankle arthroscopy with the use of the anterocentral portal. Previously described anatomic variations of the tibial artery and its close relationship with the anterior ankle capsule may complicate arthroscopic surgery, especially when aggressive synovectomy is performed. Anterior tibial artery aneurysm is a rare complication of ankle arthroscopy, but its potential catastrophic sequelae must not be underestimated.

Aneurysm, False↗

PubMed2001

Transcondylar screw fixation in anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to investigate the outcomes of 2 different methods of femoral fixation for arthroscopically assisted anterior cruciate ligament (ACL) reconstruction. TYPE OF STUDY: Double-blind prospective study. METHODS: Fifty-five patients were prospectively evaluated at 2-year follow-up. In group A, 24 patients underwent arthroscopic ACL reconstruction with bone-patellar tendon-bone and interference screw fixation. In group B, 31 patients underwent arthroscopic ACL reconstruction with bone-patellar tendon-bone and transcondylar screw fixation. Patients were evaluated by using the IKDC form, Lysholm-II form, Tegner scoring system, and KT-2000 arthrometer. RESULTS: In group A, final IKDC clinical evaluation achieved 0% grade A, 62.5% grade B, 25% grade C, and 12.5% grade D. In group B, 29.1% achieved grade A, 54.8% grade B, 12.9% grade C, and 3.2% grade D. The difference was statistically significant (P <.05). The injured versus normal side-to-side KT-2000 difference at maximum manual loading was 3.68 mm (SD, 1.71) in group A and 1.64 (SD, 2.05) in group B (P <.0001). CONCLUSIONS: This prospective study could not provide significant data suggesting that 1 method of fixation is superior to the other. Therefore, we consider both methods comparable in terms of stability and functional outcome at short-term follow-up. Transcondylar fixation offers the following advantages: fixation without intra-articular hardware, greater bone-to-bone fixation, and the possibility of fixation with breakage of the posterior femoral tunnel wall. Moreover, this method may be a useful alternative in revision ACL surgery.

Adolescent↗

PubMed2001

One-stage arthroscopically assisted anterior and posterior cruciate ligament reconstruction.

PURPOSE: To retrospectively evaluate 15 consecutive patients who underwent simultaneous isolated, arthroscopically assisted anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction. TYPE OF STUDY: Case series. METHODS: A bone-patellar tendon-bone autograft was used as the PCL substitute and doubled hamstring tendons were used as the ACL graft. The IKDC evaluation form and the HSS, Lysholm, and Tegner clinical rating scales were used to make clinical evaluations. Anteroposterior translation was measured with the KT-2000 arthrometer and stress view radiography. RESULTS: At final IKDC evaluation, 3 patients (20%) were graded A, 7 (46.7%) were graded B, 3 (20%) were graded C, and 1 patient (6.7%) was graded D. One patient underwent revision surgery in another hospital for severe postoperative residual laxity. Two C-graded patients had an unsatisfactory outcome as a result of serious complications related to knee injuries. All patients with a grade A or B returned to sports activity. At stress view examination, mean posterior side-to-side translation measured at the lateral tibial plateau was 5.8 +/- 1.1 mm and the mean translation at the medial tibial plateau was 7.3 +/- 1.5 mm; the mean anterior dislocation was 3.3 +/- 0.4 mm. The preoperative HSS score rated an average of 32 +/- 9. Postoperatively, the average score reached was 89.6 +/- 8.3. The preoperative Lysholm score was 65.5 +/- 9.1 (range, 48 to 78) in patients with chronic lesions and at follow-up was 95.1 +/- 4.5 (range, 88 to 100). The average Tegner activity score decreased in patients with chronic lesions from 6.9 +/- 1.7 (range, 4 to 9) before injury to 5.5 +/- 1.6 (range, 2 to 9) at follow-up (P =.053 ). At follow-up, 7 patients (50%) returned to their preinjury level after surgery. CONCLUSIONS: These results show the effectiveness and safety of simultaneous arthroscopic reconstruction of both cruciate ligaments using autografts that can adequately restore satisfactory stability, even in the presence of minimal peripheral laxity (1 degrees or 2 degrees ). We conclude that the use of autografts can restore ligament function with good patient compliance and without significant surgical complications.

Adolescent↗

PubMed2000

Current concepts in diagnosis and treatment of posterior cruciate ligament injury.

Injuries to the posterior cruciate ligament (PCL) have traditionally been reported to be rare but in the last decade, this ligament has captured the attention of orthopaedic surgeons world-wide. While new or improved surgical techniques involving the PCL have achieved attractive results, accurate evaluation of the PCL-deficient knee still remains a challenge. Despite the greater use of new, more sensitive clinical testing, stress radiography and MRI, correct diagnosis and staging of the PCL tear is still difficult. The objective of this paper is to provide an up-to-date review regarding diagnosis and treatment of the PCL tear.

Anterior Cruciate Ligament Injuries↗

PubMed2000

The application of shock-waves therapy in the treatment of resistant chronic painful shoulder. A clinical experience.

BACKGROUND: To evaluate the efficacy of extracorporeal shockwaves therapy (ESWT) in patients with chronic painful shoulder. METHODS EXPERIMENTAL DESIGN: a prospective design was used with a short term follow-up. SETTING: data were collected at the Service of Physioterapy in Villa Stuart Clinic-Rome. PATIENTS: 72 patients of both sexes with an average age of 38 years (range 18 to 69) affected by chronic painful shoulder, whose symptoms lasted more than 6 months. INTERVENTIONS: all patients received on average, 2,000 impulses of ESWT at level 5 energy (0.21 mJ/mm2) according to Dornier Epos equipment one session per week for 8 weeks. MEASURES: all cases underwent an instrumental examination with X-ray conventional imaging and clinical assessment of pain (visual analogue scale) and functional limitation of the shoulder, two weeks before the treatment and at one month follow-up. RESULTS: 53% of patient scored excellent results, 14% good, 13% fair and 20% poor. In the group of calcifying tendinitis we had a reduction in 37% and no changes in 63%. CONCLUSIONS: Even with a limited number of cases our early results show the efficacy and safety of ESWT in the treatment of chronic painful shoulder resistant to other conservative approaches.

Adolescent↗

PubMed1999

Magnetic resonance imaging of tunnel placement in posterior cruciate ligament reconstruction.

The aim of this study was to define a reproducible method for evaluating posterior cruciate ligament (PCL) reconstructions using magnetic resonance imaging (MRI). A 2-fold investigation was performed. In part I, the "footprints" of an intact PCL were located on MRI and their coordinates were defined. Measurements were made on the images of 50 subjects using axial, coronal, and sagittal planes. Interobserver variability was calculated by averaging the measurements of the 2 reviewers and using the Kappa coefficient. Three points of reference were located: tibial attachment on the tibial axial plane, and two femoral attachments on the sagittal and coronal oblique planes. In part II, stability of 20 PCL reconstructions with a bone-patellar tendon-bone (BPTB) autograft were evaluated and scored using the IKDC evaluation form after a 2-year follow-up. Stability was evaluated clinically and instrumentally using a KT-2000 arthrometer at 89 N with the knee flexed at a neutral quadriceps knee angle of approximately 70 degrees . Seven cases were graded A (0 to 2 mm), 11 graded B (3 to 5 mm), and 2 graded C (6 to 10 mm). All patients had an MRI after an average of 16 months (range, 12 to 24 months, 2 SD). The previous measurements from part I of the study were used to make a correlation between achieved stability and tunnel location. A 1-factor analysis of variance (ANOVA), nonparametric ANOVA, and the Fisher Exact test were used to determine if clinical outcome of the 3 groups was influenced by graft placement. At MRI evaluation, excessive deep placement was observed in 4 cases and a correlation between improper femoral tunnel location and stability was statistically significant (P < .05). A correct placement of tibial tunnel was observed in all patients. In our analysis, proper location of the femoral tunnel seems to be more critical and difficult to achieve than tibial tunnel placement, probably because of the lack of specific anatomic landmarks during surgery.

Adolescent↗

PubMed1999

A cadaveric study of endoscopic decompression of the cubital tunnel.

A cadaveric study of endoscopic decompression of the cubital tunnel was performed. Four fresh-frozen upper limbs were used for dissection, with a focus on the relationship between the ulnar nerve and Osborne's band. The endoscopic procedure was performed with the Ectra II system (Smith & Nephew, Andover, MA). After the surgical procedure, further dissection was done to evaluate the effectiveness and safety of the endoscopic cut of Osborne's band. Our conclusion is that endoscopic release is not a technically difficult procedure, and may be limited to certain clinical situations.

Cadaver↗

PubMed1999

Aberrant crypt foci in the human colon: frequency and histologic patterns in patients with colorectal cancer or diverticular disease.

Aberrant crypt foci are considered potential markers of colorectal cancer risk. The aim of this study was to analyze a large series of human aberrant crypt foci according to frequency, distribution, and histology. Aberrant crypt foci were identified in methylene blue-stained colonic mucosa from 103 patients undergoing surgery for colorectal cancer or diverticular disease. Foci were histologically classified into surface hyperplastic type, surface and glandular hyperplastic type, mixed hyperplastic and adenomatous type, and adenomatous type. The mean frequency of aberrant crypt foci (n = 720) was higher in the colorectal cancer group (0.20/cm2) than in the diverticular disease group (0.07/cm2), and in distal colonic segments than in proximal segments. Most of the histologically examined foci (n = 366) were hyperplastic (88.8%). Surface hyperplasia accounted for 30.6% and prevailed in small lesions. Surface and glandular hyperplasia accounted for 58.2% and prevailed in medium-sized to large foci. Partially or totally dysplastic foci accounted for 10.1% of examined lesions (10.8% and 2.8% in the colorectal cancer and diverticular disease groups, respectively). Most of them (94.6%) were composed of mixed hyperplastic and adenomatous crypts and prevailed in large lesions. The higher frequency of aberrant crypt foci in patients with colorectal cancer sustains their putative role as preneoplastic markers. The high rate of mixed hyperplastic and adenomatous lesions supports the possible adenomatous transformation of hyperplastic lesions.

Adenoma↗

PubMed1999

[Arthroscopic reconstruction of the posterior cruciate ligament. Magnetic resonance study for bone tunnel positioning and comparison with clinical results].

INTRODUCTION: The success of arthroscopic cruciate ligament reconstruction depends on several factors, such as patient selection, correct surgical execution, and postoperative rehabilitation. Technical considerations include graft choice, positioning, fixation, intercondylar notch enlargement, and new ligament tensioning. Graft acceptance is effected by all these factors. Tunnel position is of great importance both for biomechanical reasons and optimal function of the new ligament, and to avoid stress, friction, abnormal strain, and/or damage to the reconstructed ligament. Many orthopedic and radiographic literature studies discuss the exact site of anterior cruciate ligament insertion for the best possible anatomical reconstruction. In contrast, the debate over insertional area and anatomical landmarks is open for the posterior cruciate ligament (PCL), because of the difficult execution of this type of reconstruction and the smaller number of candidates. MATERIAL AND METHODS: Fifty patients with a healthy PCL underwent MRI of the knee for other diagnostic reasons and we measured the position of PCL insertion at the tibial and femoral condyles. We also examined with MRI 20 surgical patients with a reconstructed PCL. Graft position was assessed with the same method and the results compared with physical findings of joint stability and the IKDC form score. RESULTS: Three main landmarks were found on standard axial, coronal and sagittal MR images: T1 on the tibia, and F1 and F2 on the femur. These points refer to the fibrous ligament center and designate the medial, middle and lateral portion of the tibial plateau, as well as the anterior/posterior and high/low positions on the roof of the intercondylar notch and anteromedial side of the medial condyle, respectively. According to these data, the midline position, whether slightly medial or lateral, of tibial insertion, was clinically less important. On the contrary, correct femoral tunnel positioning was found to effect subsequent joint stability and prompt rehabilitation. CONCLUSIONS: This method for MR measurement is easy and repeatable, and can be used for surgical planning and patient follow-up. We found it extremely useful for the correct positioning of bone tunnels, particularly the femoral condyle, in all cases.

Arthroscopy↗

PubMed1999

Comparison of surgical treatments for knee dislocation.

This retrospective study compared three surgical procedures for acute knee dislocation. Eleven patients (group 1) underwent direct repair of the cruciate ligaments, 6 patients (group 2) underwent anterior cruciate ligament (ACL) reconstruction with hamstring tendons and posterior cruciate ligament (PCL) reattachment, and 6 patients (group 3) underwent PCL reconstruction with ipsilateral bone-patellar tendon-bone and ACL reconstruction with doubled semitendinosus and gracilis tendons. Average follow-up was 6.9 years (range: 24 months to 19 years). Surgical results were evaluated using the IKDC evaluation form, KT-2000 arthrometer, and Lysholm and Tegner scores. Statistical analysis was performed using Fisher's exact test and the Cochran-Mantel-Haenszel test to compare different surgical procedures. In terms of stability and range of motion, results were less favorable after direct repair and cruciate ligament reattachment. Better results were reported after combined ACL and PCL reconstruction. Average side-to-side total anteroposterior translation as measured by the KT-2000 arthrometer at 20 degrees +/- 5 degrees of knee flexion was 6.67 mm, 3.6 mm, and 3.2 mm in groups 1, 2, and 3, respectively. At final International Knee Documentation Committee (IKDC) evaluation, only 2 group 3 patients achieved a group qualification A, while a group qualification B was achieved by 5 patients (2 patients in group 1, 2 patients in group 2, and 1 patient in group 3). Nine patients in group 1, 4 patients in group 2, and 3 patients in group 3 achieved group qualifications C and D (fair or poor results). Based on these results, we do not recommend reattachment of the cruciate ligaments after knee dislocation for obtaining a stable knee with full range of motion.

Adolescent↗

PubMed1999

[Synovial healing in reconstructed cruciate ligaments. Our personal experience compared in single interventions and combined reconstructions].

INTRODUCTION: The healing process of tendon grafts used in cruciate ligament reconstruction is called ligamentization. The tendon structural architecture changes progressively into the histological appearance of normal ligament. Amiel and Clancy have demonstrated that this process is time-dependent in anterior cruciate ligament (ACL) reconstruction, the tendon graft taking one year to become similar to a normal cruciate ligament. Three different maturation phases of anterior cruciate graft ligamentization can be seen at MRI: periligamentous proliferation, intraligamentous proliferation and definitive healing. We report our MR findings in the reconstruction of single ACL, posterior cruciate ligament (PCL), and of both ACL and PCL. MATERIAL AND METHODS: January 1995 to January 1999 we selected 60 patients submitted to arthroscopic cruciate ligament reconstruction. The ACL was reconstructed with the patellar tendon in 22 cases and the PCL in 23; fifteen patients underwent double reconstruction of ACL, with hamstring tendons, and PCL, with patellar tendons. Fifty-five patients were followed-up with MRI: 45 with a dedicated permanent magnet (Artroscan, Esaote Biomedica, Genoa, Italy) and 10 with a permanent low-field unit (AIRIS, Hitachi, Japan); the same technical parameters were used in all cases. Forty of 55 patients were examined at 1, 3, 6, 9 and 12 postoperative months, while 15 were followed-up longer (12 to 36 months postoperatively). At the first follow-up MR examination, 5 patients (2 ACL and 3 PCL) were excluded for incorrect tunnel position (1 case), hypertrophic scarring (2 cases) and new trauma (2 cases). MR findings were compared with clinical data of joint stability. RESULTS: MRI showed the different stages of the healing process in 20 ACL patients: proliferating soft tissue around the graft with the low signal intensity typical of tendons (stage I, 1-3 months postoperatively), the graft becomes progressively hyperintense (stage II, 3-9 months postoperatively), and finally the low signal intensity indicating completed ligamentization (stage III, 12 months postoperatively). As for PCL reconstructions, MR findings were similar but the process took longer, even 24 months. Finally, in the 15 cases of double reconstruction, both grafts were difficult to distinguish on T1-weighted images for a very long time (24-36 months postoperatively). DISCUSSION AND CONCLUSIONS: Relative to the ACL, ligamentization takes longer for PCL and combined ACL and PCL reconstructions, probably because the morphological changes in PCL and double grafts may be impaired by many factors, such as gravity, long bone tunnels, hemarthrosis, hyperplastic synovial reaction in the intercondylar notch; also, rehabilitation protocols differ in ACL from PCL patients. No signs of instability were found at physical or arthrometric examinations. MRI demonstrates the different stages of ligamentization and thus proves a useful tool for postoperative follow-up in cruciate ligament reconstructions. Contrast-enhanced (Gd) studies are reserved to the cases of graft impingement or if other abnormalities are suspected.

Anterior Cruciate Ligament↗