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. 2022 Jan;30(1):93-101.
doi: 10.1007/s00167-021-06640-6. Epub 2021 Jun 13.

Superb microvascular imaging (SMI) detects increased vascularity of the torn anterior cruciate ligament

Satoshi Takeuchi  1   2 , Benjamin B Rothrauff  1 , Ryo Kanto  1 , Kentaro Onishi  1   3 , Freddie H Fu  4
Affiliations

Superb microvascular imaging (SMI) detects increased vascularity of the torn anterior cruciate ligament

Satoshi Takeuchi et al. Knee Surg Sports Traumatol Arthrosc. 2022 Jan.

Abstract

Purpose: Ultrasound with superb microvascular imaging (SMI) is a novel microvascular imaging technology which may be useful to assess the vascularity of the torn anterior cruciate ligament (ACL) as a potential measure of healing potential following surgery. This study aimed to quantify the vascularity of the torn and intact ACL using ultrasound with SMI.

Methods: 23 patients (mean age ± standard deviation, 27.1 ± 12.8 years), who were diagnosed with an ACL tear with an intact contralateral ACL were enrolled (ACL injury group). Ten healthy volunteers (36.1 ± 4.9 years) who had intact ACLs in both knees were also recruited (ACL healthy controls). The vascularity of the ACL was assessed using SMI within 15 mm from the tibial insertion in both knees. The amount of the vascular signal was assessed using a semi-quantitative grading scale (vascularity grade: grade 0-3) and a quantified ratio of vascularized area with respect to total area of the region of interest (vascularity ratio).

Results: In the ACL injury group, a significantly higher vascularity grade and ratio were observed in the torn ACL (vascularity grade 0-3: 1, 8, 7, and 7 patients, respectively; vascularity ratio: 1.3 ± 1.4%) than the contralateral intact ACL (vascularity grade 0-3: 21, 1, 1, and 0 patients, respectively; vascularity ratio: 0.1 ± 0.5%) (P < 0.001), whereas no significant difference was observed between both ACLs in the ACL healthy control group.

Conclusions: SMI was useful to assess the increased vascularity in torn ACL, which may reflect the potential for, or state of, ACL maturation following reconstruction or repair.

Level of evidence: Level III.

Keywords: ACL; Anterior cruciate ligament; Superb microvascular imaging; Ultrasonography; Ultrasound; Vascularity.

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