Magnetic Resonance Imaging Assessment of Anterior Cruciate Ligament Reconstruction: Structured Radiological Evaluation Methods and Reporting Template

Anterior cruciate ligament (ACL) injuries are frequent, especially in athletic populations and are often managed with surgical reconstruction to restore knee stability and function. The frequency of these procedures underscores the importance of accurate, standardized, and reproducible postoperative imaging for the assessment of surgical outcomes, early detection of complications, and evaluation of graft maturation. Postoperative assessment begins with understanding the type of graft used for reconstruction, which commonly includes bone–patellar tendon–bone, hamstring, or quadriceps tendon autografts. Graft size, signal intensity, and integration with bone tunnels are critical to evaluate the long-term success of the procedure. Graft maturation can be assessed using signal characteristics and semiquantitative scoring systems such as Figueroa's score. Correct femoral and tibial tunnel positioning mimics the native ACL's anatomical footprint and orientation. Important metrics such as tunnel angles and the tunnel's relationship to anatomical landmarks are essential components of the structured report. This article consolidates current knowledge and provides a pictorial review of radiological measurements and summarizes a clinically practical magnetic resonance imaging reporting template that includes all essential postoperative metrics. The format is intended to be used not only by radiologists but also by orthopaedic surgeons for comprehensive postoperative evaluation and follow-up.