ArticleLa Radiologia medica2026
Radiologic maturation and tunnel changes after all-inside versus standard hamstring ACL reconstruction: a prospective comparative study.
Article in La Radiologia medica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo 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
methodsThis 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.
resultsForty 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.
conclusionsAI-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.
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