Arthroscopic ACL reconstruction with Δ plasty: an innovative approach with hamstrings’ transfer and double tibial tunnel

Abstract

We propose a new technique, with double bundle, double tibial tunnels with a bridge between them, using the hamstrings as auto-grafts, retaining either their central or peripheral attachment. A prospective series of 41 patients underwent primary reconstruction of the anterior cruciate ligament by one surgeon, arthroscopically and electronically assisted; 37 were men and 4 were women with a mean age of 24.7 years. The mean follow-up was 19.05 (12-30) months. Normal function and joint stability was achieved. The patients returned to full occupational activities within 3-6 months after the operation. The function of hamstrings was not disturbed. Two patients have sustained a new injury without rupture of the grafts. The Noulis-Lachman test was negative in 35 knees. Positive Pivot shift, post-operatively, was present in 15.45% of patients. The IKDC score was 84.55. In the proposed ACL reconstruction technique, the two tendons are transferred and used as grafts, with gracillis and semitendinosus retaining their distal and central attachment, respectively; the former superimposed upon the latter while entering the femoral tunnel. The tibial tunnels leave a bone bridge ranging between 12 and 15 mm within the footprints of ACL. The two bundles are tensioned, each at different angle. This configuration imitates both the anatomy and the function of ACL and controls not only the anterior translation, but also the rotatory stability. With this innovative technique, the final outcome is improved, thus being closer to normal, as evidenced from previous experiments and the present prospective series.

Comparison of anterior cruciate ligament reconstruction methods between reverse “Y” plasty reconstruction and traditional single-bundle technique—A cadaveric study

“…The newly improved technique of the ACL reconstruction in the study is similar to that proposed by George Papachristou [8] in 2008. In their biomechanics study, they used “Δ” plasty technique to reconstruct ACL, with two separate tibial tunnels and a femoral tunnel.…”

“…ACL reconstruction, with a success rate >90% [3] , has been the most effective way to treat ACL rupture. Surgeons refined surgical approach with many reconstructive techniques over the past years, such as the single-bundle technique, anatomic double-bundle reconstruction technique [4] , [5] , triple-bundle reconstruction technique [6] , [7] , plasty reconstruction technique [8] , etc.…”

Preserving the Semitendinosus Distal Attachment Is Associated With Improved Graft Remodeling After ACL Reconstruction

“…This is consistent with published studies of hamstring grafts. 20,21,28,41,46,47,54,57 It is difficult to show a statistically significant difference in the functional outcomes between different techniques because the results are so good with these techniques to start with. 4,30,34,49 Putnis et al 45 showed an association between a high signal intensity ratio (SIR) on MRI scans at 1 year and the graft retear rate.…”

“…40 This idea has been around since the 2000s. 4,30,41,55,57 Several different techniques have been described, but none use only the ST. 50,58 Consequently, the outcomes of the aST method are not well known. Furthermore, no study has directly compared the remodeling of aST with the standard free ST.…”

Return to Sport after ACL Surgery: A Comparison between Two Different Reconstructive Techniques

“…26 This benefit results in proprioception improvement that allows for a more intensive rehabilitation program aimed at a faster return to sport with a performance nearing the preinjury level. 11,[27][28][29][30][31][32] This study has some limitations. Its monocentric design and the low number of patients enrolled do not allow to draw definitive conclusions about the researched topic.…”