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

MRI Assessment of Postoperative Complications Following ACL Reconstruction using Hamstring or Peroneus Longus Tendon Autografts

Abstract

Background: The anterior cruciate ligament (ACL) is a commonly injured knee ligament. It is often reconstructed surgically. MRI is a non-invasive modality for evaluating graft integrity and post-surgical complications. Objective: To determine the frequency of complications on MRI in postoperative patients undergoing ACL reconstruction using hamstring or peroneus longus tendon autografts. Study Design: Descriptive cross-sectional study. Settings: The study was conducted in the Department of Radiology, Faisalabad Medical University & Allied Hospitals, Faisalabad Pakistan. Duration: 30th March to 29th September 2023. Methods: A total of 205 patients who had undergone ACL reconstruction (hamstring autograft, n=128; peroneus longus autograft, n=77) were included by consecutive sampling. MRI was performed on a 1.5T scanner using standardized SE T1W, FS T2W, and STIR sequences. Tunnel widening, tibial cystic degeneration, arthrofibrosis/Cyclops lesion, and partial and complete graft tears were assessed against established MRI diagnostic criteria by a consultant radiologist blinded to clinical findings. The data were analyzed with SPSS v25.0. The chi-square test was used to stratify by age, gender, time since reconstruction, and affected side (p≤0.05). Results: The mean age was 36.5 ± 9.1 years. Of the total 205 patients, 64.4% were males. Mean duration since reconstruction was 3.9 ± 1.3 months. Complications noted were tunnel widening in 15.1%, tibial cystic degeneration in 6.3%, arthrofibrosis/Cyclops lesion in 3.4%, partial graft tear in 9.6%, and complete graft tear in 21.0%. Complications were significantly associated with gender (p<0.05), duration since reconstruction (p<0.05), and side affected (p<0.05). Conclusion: MRI is a valuable modality for detecting complications after ACL reconstruction. Rather than routine surveillance of all patients, targeted MRI is recommended for those with persistent symptoms or clinical suspicion of graft failure, enabling early identification and management and improving long-term functional outcomes in Pakistani patients.