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Primary imaging endpoints were graft signal-to-noise quotient (SNQ, PD-FS) and tibial tunnel cross-sectional area (CSA) change; clinical endpoints included PROMs and laxity at\u2009\u2265\u200924 months. Reliability was assessed with two independent evaluators and reported using ICC (two-way random, absolute agreement) with 95% CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920 per group) completed MRI at 12 months and clinical follow-up at 24 months. SNQ was similar between groups (ST4 1.94 [95% CI 1.28\u20132.60] vs DSTG 2.84 [1.93\u20133.75]; difference\u2009\u2212\u20090.90 [\u2212\u20091.99 to 0.19],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.39). Tibial tunnel widening was lower with ST4 (45.5% [23.7\u201367.3]) versus DSTG (106.7% [78.3\u2013135.1]); difference\u2009\u2212\u200961.2% [\u2212\u200995.8 to\u2009\u2212\u200926.6];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.02. PROMs and laxity were comparable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AI-ST4 and DSTG ACL reconstruction demonstrated similar graft maturation at 12\u00a0months, with less tibial tunnel widening after AI-ST4. At 24\u00a0months, clinical outcomes were equivalent between groups; although SNQ and tibial tunnel CSA demonstrated good reproducibility, these imaging differences were not demonstrably associated with functional superiority.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11547-026-02177-1","type":"journal-article","created":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T12:02:14Z","timestamp":1771675334000},"page":"1000-1009","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiologic maturation and tunnel changes after all-inside versus standard hamstring ACL reconstruction: a prospective comparative study"],"prefix":"10.1007","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0700-8139","authenticated-orcid":false,"given":"Alessandro","family":"Carrozzo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2377-4829","authenticated-orcid":false,"given":"Edoardo","family":"Monaco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3465-9781","authenticated-orcid":false,"given":"Nicola Carlo","family":"Bianco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1043-7567","authenticated-orcid":false,"given":"Etienne","family":"Cavaignac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0108-5347","authenticated-orcid":false,"given":"Edoardo","family":"Gaj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7986-9232","authenticated-orcid":false,"given":"Riccardo","family":"Di Niccol\u00f2","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7339-5387","authenticated-orcid":false,"given":"Alessandro","family":"Annibaldi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2408-5307","authenticated-orcid":false,"given":"Adnan","family":"Saithna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5327-3702","authenticated-orcid":false,"given":"Nicola","family":"Maffulli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,21]]},"reference":[{"key":"2177_CR1","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1007\/s00167-022-07005-3","volume":"31","author":"S Cerciello","year":"2023","unstructured":"Cerciello S, Ollivier M, Kocaoglu B et al (2023) ACL surgical trends evolve in the last five years for young European surgeons: results of the survey among the U45 ESSKA members. 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Edoardo Monaco is a consultant for Arthrex. Adnan Saithna is a consultant for Arthrex and member of the Editorial Board of Arthroscopy Journal. Nicola Maffulli is in Editorial or Governing Board of Foot and Ankle International, Knee, Knee Surgery, Sports Traumatology, Arthroscopy, Muscles Ligaments Tendons Journal, Sports Medicine, and Arthroscopy Review, Springer, and is a Board of Directors member for EFOST, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine. The other authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was obtained from the institutional ethics committee.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors affirm that human research participants provided informed consent for publication of anonymized data and images included in this article.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}]}}