What "Changes of Prior ACL Reconstruction" Means on X-ray Report
"Changes of prior ACL reconstruction" on an X-ray report indicates the radiologist has identified evidence of previous ACL surgery, including hardware (screws, buttons, or anchors), bone tunnel placement, and sometimes bone remodeling or tunnel widening at the sites where the graft was anchored. 1, 2
Specific Radiographic Findings
The radiologist is documenting visible surgical alterations from your previous ACL reconstruction, which typically include:
- Hardware presence: Metallic interference screws, endobuttons, or other fixation devices in the femur and/or tibia where the graft was secured 1, 2
- Bone tunnels: Drill holes through the tibia and femur where the graft was passed, which appear as lucent channels on X-ray 2, 3
- Bone remodeling: Healing changes around the tunnel sites, which may show sclerosis (increased bone density) or widening over time 1, 3
- Graft calcification: Occasionally, the soft tissue graft itself may show some calcification visible on X-ray 2
Clinical Significance
This finding is typically descriptive rather than diagnostic of a problem. 4 The radiologist is simply documenting that you've had prior surgery. However, the report may prompt further evaluation if:
- You're experiencing new symptoms (pain, instability, swelling) that could indicate graft failure, hardware complications, or infection 5, 1
- There's concern for hardware migration, loosening, or fracture 2, 3
- Tunnel widening is excessive, which could complicate potential revision surgery 6, 3
Important Caveats
X-rays have significant limitations for evaluating ACL graft integrity. 1, 2 Standard radiographs cannot directly visualize the soft tissue graft itself or assess whether it's intact, torn, or stretched. 1, 3 If there's clinical concern about graft failure or other soft tissue complications (impingement, arthrofibrosis, graft tears), MRI is the imaging modality of choice. 1, 2, 3
Routine postoperative X-rays after uncomplicated ACL reconstruction have questionable clinical utility, with 97.7% reading as normal and rarely changing management. 4 X-rays are most useful when there's specific concern for hardware issues, fracture, or infection rather than routine surveillance. 5, 4