ArticleJournal of orthopaedic case reports2026
Anterior Cruciate Ligament Reconstruction Using Tibial Attachment - Preserving Hamstring Grafts: Early Clinical and Magnetic Resonance Imaging Assessment of Graft Ligamentization.
Article in Journal of orthopaedic case reports, 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
Introduction: Hamstring (HS) tendon autografts are widely used for anterior cruciate ligament (ACL) reconstruction. Conventional graft harvesting requires detachment from the tibial insertion, which may compromise graft vascularity and result in early graft necrosis during ligamentization. Preservation of the tibial attachment may help maintain the intrinsic blood supply and enhance early graft viability. However, magnetic resonance imaging (MRI)-based evidence evaluating graft behavior during the early necrotic-proliferative phase remains limited. Materials And Methods: This prospective observational study included 30 patients who underwent anatomic single-bundle ACL reconstruction using a tibial attachment-preserving HS tendon autograft. Clinical stability was assessed using Lachman and pivot shift tests, while functional outcomes were evaluated using the Lysholm knee score and Tegner activity level. MRI assessment was performed at 8 weeks postoperatively to evaluate early graft morphology and signal intensity during the biologically vulnerable phase of ligamentization. Graft signal intensity was graded using the Figueroa classification. All patients were followed clinically for a minimum of 6 months. Results: The mean Lysholm knee score improved from 54.4 preoperatively to 92.4 at final follow-up, while the mean Tegner activity level increased from 3 to 5.27. At final follow-up, the pivot shift test was negative in all patients. Lachman testing demonstrated grade 0 laxity in 29 patients and grade 2 laxity in one patient. MRI at 8 weeks confirmed anatomically positioned grafts in all cases. Hypointense or isointense graft signal intensity was observed in 29 patients, whereas one patient demonstrated hyperintense signal characteristics. Conclusion: ACL reconstruction using a tibial attachment - preserving HS autograft resulted in favorable early clinical stability and functional recovery. Early MRI findings demonstrated predominantly hypo- to isointense graft signals, suggesting preservation of graft morphology during the early phase of ligamentization. Larger comparative studies with longer follow-up are needed to determine the long-term clinical relevance of these findings. Level of evidence: Level IV, prospective observational study.
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