Tunnel placement in anterior cruciate ligament reconstruction: MRI analysis as an important factor in the radiological report

Objective. Correct placement of tunnels for anterior cruciate ligament (ACL) reconstruction is of prime importance for the clinical outcome of the patient. In this study, the possibility of using MRI to document tunnel placement and provide a more comprehensive report following ACL reconstruction was explored at no additional cost in patients scheduled for routine knee MRI. Design and patients. One year after ACL reconstruction, 45 patients underwent clinical examination (IKCD score), radiographic examination, and MRI using a 1.5-T unit. Results. Twenty patients with good tibial and femoral attachment results were found at clinical examination to have a stable knee joint with a full range of motion. In 25 patients with suboptimal placements, examination showed either a stable knee with a decreased range of motion or instability with a normal range of motion. Conclusion. Patients’ clinical outcome, and the radiographic and MRI findings, correlated closely with the quality of operative tunnel placement. A record of this finding is important for completeness of the radiological report. Furthermore the MRI findings can be used to improve the surgical quality of tunnel placement. Because tunnel placement can be shown adequately with radiography, however, MRI cannot be justified for this reason alone, so such assessment is advised only when MRI is needed to show all postoperative features.