Surgical reconstruction is the current standard for ACL rupture treatment in active individuals. Recently, there is renewed interest in primary repair of proximal ACL tears. Despite this, ACL biology and healing potential are currently not well understood. Vascularity is paramount in ACL healing; however, previous ACL vascularity studies have been limited to qualitative histological and dissection-based techniques. The study objective was to use contrast-enhanced quantitative-MRI to compare relative perfusion of proximal, middle, and distal thirds of the in situ ACL. We hypothesized perfusion would be greatest in the proximal third. Fourteen cadaveric knees were studied (8 females, 6 males), age 25–61 years. Superficial femoral, anterior tibial, and posterior tibial arteries were cannulated; without intraarticular dissection. Contrast-enhanced quantitative-MRI was performed using a previously established protocol. ACL regions corresponding to proximal, middle, and distal thirds were identified on sagittal-oblique pre-contrast images. Signal enhancement (normalized to tibial plateau cartilage) was quantified to represent regional perfusion as a percentage of total ACL perfusion. Comparative statistics were computed using repeated measures ANOVA, and pairwise comparisons performed using the Bonferroni method. Relative perfusion to proximal, middle, and distal ACL zones were 56.0% ±17.4%, 28.2% ±14.6%, and 15.8% ±16.3%, respectively (p = 0.002). Relative perfusion to the proximal third was significantly greater than middle (p = 0.007) and distal (p = 0.001). No statistically relevant difference in relative perfusion was found to middle and distal thirds (p = 0.281). Post-hoc subgroup analysis demonstrated greater proximal perfusion in males (66.9% ± 17.3%) than females (47.8% ± 13.0%), p = 0.036. Using quantitative-MRI, in situ adult ACL demonstrated greatest relative perfusion to the proximal third, nearly 2 times greater than the middle third and 3 times greater than the distal third. Knowledge of differential ACL vascular supply is important for understanding pathogenesis of ACL injury and the process of biological healing following various forms of surgical treatment.

中文翻译：

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人前交叉韧带的差异区域灌注：定量磁共振成像评估

手术重建是活动个体 ACL 断裂治疗的当前标准。最近，对近端 ACL 撕裂的一期修复重新产生了兴趣。尽管如此，ACL 生物学和愈合潜力目前还不是很清楚。血管在 ACL 愈合中至关重要；然而，以前的 ACL 血管分布研究仅限于定性组织学和基于解剖的技术。研究目的是使用对比增强定量 MRI 来比较原位 ACL 近端、中间和远端三分之一的相对灌注。我们假设灌注在近端三分之一处最大。研究了 14 个尸体膝盖（8 名女性，6 名男性），年龄 25-61 岁。股浅动脉、胫前动脉和胫后动脉插管；无关节内剥离。使用先前建立的方案进行对比增强定量 MRI。在矢状斜预对比图像上识别出对应于近端、中间和远端三分之一的 ACL 区域。信号增强（标准化为胫骨平台软骨）被量化以表示区域灌注占总 ACL 灌注的百分比。使用重复测量方差分析计算比较统计数据，并使用 Bonferroni 方法进行成对比较。ACL 近端、中间和远端区域的相对灌注分别为 56.0% ±17.4%、28.2% ±14.6% 和 15.8% ±16.3% (p = 0.002)。近端三分之一的相对灌注显着大于中间（p = 0.007）和远端（p = 0.001）。中间和远端三分之一的相对灌注没有统计学相关差异（p = 0.281）。事后亚组分析表明，男性（66.9% ± 17.3%）的近端灌注高于女性（47.8% ± 13.0%），p = 0.036。使用定量 MRI，原位成人 ACL 显示近端三分之一的相对灌注最大，几乎是中间三分之一的 2 倍，是远端三分之一的 3 倍。了解不同的 ACL 血管供应对于了解 ACL 损伤的发病机制和各种形式的手术治疗后的生物愈合过程非常重要。