{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T02:44:25Z","timestamp":1775616265100,"version":"3.50.1"},"reference-count":55,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Anterior cruciate ligament reconstruction (ACLR) with autologous hamstring tendon is the standard treatment for ACL rupture. However, tibial tunnel enlargement and delayed graft maturation may affect long\u2010term outcomes. Evidence on their mid\u2010 to long\u2010term associations with clinical recovery remains limited. The main objectives of this study include: (i) analyze longitudinal changes in tibial tunnel morphology after single\u2010bundle ACLR; (ii) quantitatively evaluate graft maturation at different tunnel regions using the signal intensity ratio (SIR) from MRI; and (iii) examine the correlations between tibial tunnel enlargement, graft healing, and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective study was conducted on 35 patients who underwent single\u2010bundle ACLR using autologous hamstring grafts and completed a 5\u2010year follow\u2010up. Knee function was evaluated preoperatively and at 2 and 5\u2009years postoperatively using the KT\u20102000 arthrometer, pivot\u2010shift test (PST) grade, Lysholm Knee Scoring Scale, International Knee Documentation Committee (IKDC) questionnaire, Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, and the Anterior Cruciate Ligament\u2010Return to Sport after Injury (ACL\u2010RSI) scale. Tibial tunnel diameter was measured via MRI at 1\u2009week, 2\u2009years, and 5\u2009years postoperatively. Graft maturation was evaluated using the signal intensity ratio (SIR). Changes in tunnel diameter and SIR over time were analyzed. Pearson correlation coefficients (\n                      <jats:italic>r<\/jats:italic>\n                      ) were used to assess the relationship between bone tunnel enlargement (BTE), graft healing, and knee function. Spearman's rank correlation coefficient was used to assess the association between BTE and PST grade.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Tibial tunnel diameter increased from 1\u2009week to 2\u2009years and partially regressed at 5\u2009years, remaining larger than baseline. SIR increased significantly from 1\u2009week to 2\u2009years and decreased slightly by 5\u2009years. At 2\u2009years, tunnel diameter in the tibial tunnel exit (ttE) region was positively correlated with intra\u2010articular graft SIR (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.455,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), but not with clinical outcomes. By 5\u2009years, no significant correlation was observed between tibial tunnel diameter and graft SIR. However, tibial tunnel diameter in the ttE region was positively correlated with KT\u20102000 side\u2010to\u2010side difference (SSD) (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.411,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tibial tunnel enlargement progressed until 2\u2009years post\u2010ACLR, then partially regressed by 5\u2009years. BTE was associated with graft healing at 2\u2009years and with anterior knee stability at 5\u2009years but had no significant adverse impact on long\u2010term clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70287","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:36:02Z","timestamp":1773927362000},"page":"755-764","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mid\u2010Term Tibial Tunnel Enlargement and Graft Maturation After\n                    <scp>ACL<\/scp>\n                    Reconstruction: A 5\u2010Year Follow\u2010Up Linking Morphological Dynamics to Knee Function"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3549-3444","authenticated-orcid":false,"given":"Wenbo","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Sports Medicine and Rehabilitation Beijing Chaoyang Hospital, Capital Medical University  Beijing China"},{"name":"School of Sports Medicine and Rehabilitation Beijing Sport University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine and Rehabilitation Beijing Chaoyang Hospital, Capital Medical University  Beijing China"},{"name":"National Institute of Sports Medicine  Beijing China"},{"name":"National Institute of Key Laboratory of Sports Trauma and Rehabilitation of General Administration of Sport of China  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine and Rehabilitation Beijing Chaoyang Hospital, Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaohan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine and Rehabilitation Beijing Chaoyang Hospital, Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bingying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine and Rehabilitation Beijing Chaoyang Hospital, Capital Medical University  Beijing China"},{"name":"School of Sports Medicine and Rehabilitation Beijing Sport University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingyi","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine and Rehabilitation Beijing Chaoyang Hospital, Capital Medical University  Beijing China"},{"name":"School of Sports Medicine and Rehabilitation Beijing Sport University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine and Rehabilitation Beijing Chaoyang Hospital, Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingze","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine and Rehabilitation Beijing Chaoyang Hospital, Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingbin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine and Rehabilitation Beijing Chaoyang Hospital, Capital Medical University  Beijing China"},{"name":"National Institute of Key Laboratory of Sports Trauma and Rehabilitation of General Administration of Sport of China  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/2325967118800298"},{"key":"e_1_2_13_3_1","article-title":"Tackling the Challenges of Graft Healing After Anterior Cruciate Ligament Reconstruction\u2010Thinking From the Endpoint. 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