MR imaging plays an important role in evaluating the integrity of the ACL graft, as well as in 
diagnosing complications associated with ACL reconstruction. Patient & Methods: This study 
included 34 patients aged from 17 to 47 years (mean 29 years). MRI study assessed: pattern of the 
ACL graft (discontinuity, SI, orientation), presence or absence of graft impingement, ganglion cyst, 
arthrofibrosis, and hardware malposition. Associated knee injuries were also evaluated. Results: graft 
tear was the commonest finding (71%) in the included Cases. There was significant positive 
correlation between SI and orientation of the grafts with their tear. The MRI study revealed graft 
complications in 59% of cases: impingement in 12, Ganglion Cyst in 6, cyclops in 4, and hardware 
mal-position (loose femoral screw) in 2. Images of impingement cases showed increasing in the graft 
SI, lax orientation, and tear (partial or complete). Regarding ganglion cyst cases, all grafts had 
increased SI and most of them were lax and partially torn. Grafts in cyclops cases were normal SI, 
normal orientation, and intact. Graft discontinuity correlated with impingement positively, with
ganglion cyst and cyclops negatively. Conclusion: MRI represents an important tool for assessment 
of the complication following ACL graft reconstruction. The most frequent complication was Graft 
tear followed by impingement. Graft SI and orientation is very helpful parameters in diagnosis of 
graft complications.