Integration of Anterior and Posterior Ultrasonography for Comprehensive Anterior Cruciate Ligament Visualization: A Novel Approach

Objective

Alternative medical imaging techniques are necessary to address the limitations of magnetic resonance imaging (MRI). Therefore, this study aimed to develop an ultrasonographic method that integrates anterior and posterior approaches for measuring the entire length of the anterior cruciate ligament (ACL). We validated this method by identifying the middle ACL during arthroscopy and comparing the results to those of MRI. We hypothesized that the ACL length measurements obtained via ultrasonography and MRI would not differ significantly and that the posterior approach would provide a longer visual field of the ACL than the anterior approach.

Methods

Thirty-six patients (21 males, 15 females) diagnosed with meniscal injury or internal knee derangement were included. During arthroscopy, the surgeon identified the middle ACL using Ti-Cron™ sutures. Ultrasonographic approaches from the anterior and posterior perspectives were used to identify the distal and proximal ACL, respectively. The ACL length was measured using both ultrasonography and MRI, and the visual fields from both approaches were compared.

Results

One participant was excluded because of a torn ACL, and seven participants were excluded because of poor ultrasonographic image quality. The ACL length of the 28 included patients did not differ significantly between ultrasonography and MRI, with a moderate correlation between the two measurements. The visualized proportion of the ACL was greater through the posterior approach than through the anterior approach.

Conclusions

This ultrasonographic method visualizes the entire ACL length by combining anterior and posterior approaches, with the posterior offering a more extensive and clinically significant visual field.