ACL重建术后腘绳肌腱移植物重塑的关键3至6个月阶段：对安全重返运动的意义
简介
本研究采用“Ribbon”技术行前交叉韧带重建（ACLR）后，通过MRI信号强度（SI）评估股四头肌腱移植物的愈合过程。共纳入75例患者，术后3、6、9、12个月测量移植物前-后交叉韧带比值（APR），并与正常ACL对比。关键发现：术后3-6个月，所有区域移植物SI中位数均升高，随后下降；远端区域APR始终最高，且重塑最慢（可能因血供较差）。术后6个月和12…
英文摘要
PURPOSE: This study evaluates the temporal changes in magnetic resonance imaging (MRI) signal intensity (SI) of quadriceps tendon (QT) grafts during the healing period after anterior cruciate ligament reconstruction (ACLR) using the 'Ribbon' surgical technique and compares these findings with the SI of the native ACL. METHODS: MRI SI of QT grafts was analyzed in a cohort of 75 patients who underwent ACLR using the M-ARS (Medacta Anatomic Ribbon Surgery) technique at 3, 6, 9 and 12 months post-operatively. The anterior-to-posterior cruciate ligament ratio (APR) was calculated for the proximal, middle and distal regions of the ACL graft and compared with the reference APR of the native ACL. RESULTS: Median SI increased between the third and sixth post-operative months across all graft regions, followed by a subsequent decline. The distal segment consistently exhibited a higher APR at all time points. At 3 months, all regions except the proximal one differed significantly from the reference cohort. Notably, at 6 and 12 months, 35% and 22% of patients, respectively, presented values outside the expected range of the reference group. CONCLUSION: The period between 3 and 6 months after surgery represents a critical phase for graft maturation, with the distal section of the graft showing the slowest remodelling process, likely due to inferior vascularization. Even at 12 months, SI values had not reached those characteristic of the native ACL. This study highlights the clinical relevance of monitoring graft healing via MRI to guide rehabilitation progression and safe return-to-sport timing, emphasizing the critical 3- to 6-month period when graft biomechanical properties are lowest, and remodelling is incomplete, a factor often overlooked in current functional and psychological return-to-sport criteria. LEVEL OF EVIDENCE: Level III.