Temporal and spatial graft maturation patterns and associated factors after double-bundle anterior cruciate ligament reconstruction: A retrospective cohort study.

Authors

Hiroaki Fukushima, Shunta Hanaki, Kensaku Abe, Kyohei Ota, Masayasu Shimoda, Koshiro Matsumoto, Makoto Kobayashi, Yusuke Kawanishi, Jiro Kato, Masahito Yoshida, Tetsuya Takenaga, Hideki Murakami, Masahiro Nozaki

Published in

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. Sep 17, 2026. Epub Sep 17, 2026.

Abstract

Graft maturation after anterior cruciate ligament reconstruction is not uniform, but bundle- and segment-specific patterns after double-bundle reconstruction (DB-ACLR) remain poorly characterised. Factors associated with 2-year graft SNQ, including graft geometry, have not been fully established.
In this retrospective cohort study, patients who underwent primary DB-ACLR with hamstring autografts were included. Postoperative magnetic resonance imaging (MRI) was performed at approximately 6 months, 1 year, and 2 years using a sagittal fat-saturated proton density-weighted sequence. The signal-to-noise quotient (SNQ) was measured separately for the anteromedial bundle (AMB) and posterolateral bundle (PLB), each divided into proximal, middle, and distal segments. Factors associated with 2-year SNQ were examined using multivariable linear regression. Patient-reported outcome measures (PROMs) were collected at 2 years.
Of 472 screened patients, 167 had MRI suitable for SNQ analysis. After excluding 19 with graft failure within 2 years, 148 patients with intact grafts comprised the analysis cohort; 74 with MRI at all three time points formed the longitudinal subgroup. The PLB had consistently higher SNQ than the AMB at all time points (all P < 0.001). Distal segments showed increasing SNQ over time. Greater graft inclination angle was independently associated with lower 2-year SNQ in both bundles (AMB: B = -0.43 per 1°; PLB: B = -0.47 per 1°; both P < 0.001). No correlation was found between 2-year SNQ and PROMs.
Graft maturation after DB-ACLR was heterogeneous across bundles and segments. SNQ was consistently higher in the PLB than the AMB, and distal-segment SNQ increased over time, reaching significance in the PLB. A greater graft inclination angle was independently associated with lower 2-year SNQ, whereas 2-year SNQ was not correlated with PROMs.

PMID:
42754480
Bibliographic data and abstract were imported from PubMed on 18 Sep 2026.

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