Magnetic Resonance Imaging (MRI) Evaluation of Post-Operative Complications in Anterior Cruciate Ligament Repair Using Peroneus or Hamstring Muscle Grafts: A Cross-Sectional Study from Pakistan

Abstract

Abstract

Background: The anterior cruciate ligament (ACL) is the most commonly injured knee ligament, often requiring surgical reconstruction with autografts such as hamstring or peroneus tendon. Post-operative complications may compromise functional outcomes, necessitating accurate imaging follow-up. Magnetic resonance imaging (MRI) is a reliable non-invasive modality for evaluating graft integrity and post-surgical complications, but local data from Pakistan remain scarce.
Objective: To determine the frequency of complications on MRI in post-operative patients of ACL repair using peroneus or hamstring grafts.

Desing: Descriptive cross-sectional study

Place and Duration: Study was conducted in Department of Radiology, Faisalabad Medical University & Allied Hospitals, Faisalabad, from 11^th May to 10^th November 2025.

Methodology: A total of 205 patients (15–65 years) with ACL repair were enrolled by consecutive sampling. Patients with pacemakers or claustrophobia were excluded. MRI was performed using a 1.5T scanner with SE T1W, FS T2W, and STIR sequences. Complications assessed included tunnel widening, tibial cystic degeneration, arthrofibrosis/Cyclops lesion, partial graft tear, and complete graft tear. Data were analyzed using SPSS v25.0. Stratification was performed for age, gender, duration since repair and affected side, with chi-square applied (p≤0.05 significant).

Results: The mean age was 36.5 ± 9.1 years, with 64.4% males. Mean repair duration was 3.9 ± 1.3 months. Complications observed were: tunnel widening (15.1%), tibial cystic degeneration (6.3%), arthrofibrosis/Cyclops lesion (3.4%), partial graft tear (9.6%), and complete graft tear (21.0%). Complications were significantly associated with gender (p<0.05), duration since repair (p<0.05), and side affected (p<0.05).

Conclusion: MRI is a valuable modality for detecting post-ACL reconstruction complications, particularly graft tears and tunnel-related changes. Routine MRI follow-up is recommended for early identification and management, thereby improving long-term functional outcomes in Pakistani patients.