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Purpose <p>To compare MRI-based graft maturation and tibial tunnel behavior in all-inside anterior cruciate ligament (ACL) reconstruction using either a quadrupled semitendinosus (ST4) graft or a standard doubled semitendinosus–gracilis (DSTG) technique and to assess mid-term clinical outcomes.</p> Materials and methods <p>This is a single-center prospective comparative cohort with sequential, non-randomized allocation. Primary imaging endpoints were graft signal-to-noise quotient (SNQ, PD-FS) and tibial tunnel cross-sectional area (CSA) change; clinical endpoints included PROMs and laxity at ≥ 24 months. Reliability was assessed with two independent evaluators and reported using ICC (two-way random, absolute agreement) with 95% CIs.</p> Results <p>Forty patients (<i>n</i> = 20 per group) completed MRI at 12 months and clinical follow-up at 24 months. SNQ was similar between groups (ST4 1.94 [95% CI 1.28–2.60] vs DSTG 2.84 [1.93–3.75]; difference − 0.90 [− 1.99 to 0.19], <i>P</i> = 0.39). Tibial tunnel widening was lower with ST4 (45.5% [23.7–67.3]) versus DSTG (106.7% [78.3–135.1]); difference − 61.2% [− 95.8 to − 26.6]; <i>P</i> = .02. PROMs and laxity were comparable.</p> Conclusions <p>AI-ST4 and DSTG ACL reconstruction demonstrated similar graft maturation at 12&#xa0;months, with less tibial tunnel widening after AI-ST4. At 24&#xa0;months, clinical outcomes were equivalent between groups; although SNQ and tibial tunnel CSA demonstrated good reproducibility, these imaging differences were not demonstrably associated with functional superiority.</p>

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Radiologic maturation and tunnel changes after all-inside versus standard hamstring ACL reconstruction: a prospective comparative study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月21日

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  • Alessandro Carrozzo,
  • Edoardo Monaco,
  • Nicola Carlo Bianco,
  • Etienne Cavaignac,
  • Edoardo Gaj,
  • Riccardo Di Niccolò,
  • Alessandro Annibaldi,
  • Adnan Saithna,
  • Nicola Maffulli

摘要

Purpose

To compare MRI-based graft maturation and tibial tunnel behavior in all-inside anterior cruciate ligament (ACL) reconstruction using either a quadrupled semitendinosus (ST4) graft or a standard doubled semitendinosus–gracilis (DSTG) technique and to assess mid-term clinical outcomes.

Materials and methods

This is a single-center prospective comparative cohort with sequential, non-randomized allocation. Primary imaging endpoints were graft signal-to-noise quotient (SNQ, PD-FS) and tibial tunnel cross-sectional area (CSA) change; clinical endpoints included PROMs and laxity at ≥ 24 months. Reliability was assessed with two independent evaluators and reported using ICC (two-way random, absolute agreement) with 95% CIs.

Results

Forty patients (n = 20 per group) completed MRI at 12 months and clinical follow-up at 24 months. SNQ was similar between groups (ST4 1.94 [95% CI 1.28–2.60] vs DSTG 2.84 [1.93–3.75]; difference − 0.90 [− 1.99 to 0.19], P = 0.39). Tibial tunnel widening was lower with ST4 (45.5% [23.7–67.3]) versus DSTG (106.7% [78.3–135.1]); difference − 61.2% [− 95.8 to − 26.6]; P = .02. PROMs and laxity were comparable.

Conclusions

AI-ST4 and DSTG ACL reconstruction demonstrated similar graft maturation at 12 months, with less tibial tunnel widening after AI-ST4. At 24 months, clinical outcomes were equivalent between groups; although SNQ and tibial tunnel CSA demonstrated good reproducibility, these imaging differences were not demonstrably associated with functional superiority.