Arthroscopic ACL reconstruction with reverse “Y”-plasty grafts and fixation in the femur with either a bioabsorbable interference screw or an Endobutton

Abstract

We propose a new reverse “Y”-plasty graft for use in anterior cruciate ligament (ACL) reconstruction that involves double tibial tunnels and a single femoral tunnel. With this technique, the hamstrings were used as autografts and fixed separately with bioabsorbable interference screws (group A) or Endobuttons (group B) in femurs. A prospective series of 63 patients underwent primary reconstruction of the ACL; all procedures were performed by the same surgeon. Group A included 35 patients (22 male, 13 female), with a mean age of 25.5 (17–40) years, who were followed up for 28.5 (12–48) months. Group B included 28 patients (17 male, 11 female), with a mean age of 24.3 (18–38) years, who were followed up for 29.5 (12–46) months. Lysholm, International Knee Documentation Committee (IKDC) and Larson scoring were used to compare the therapeutic effects experienced at the knee. Lysholm scores were 93.26±2.67 (group A) and 93.81±2.42 (group B); Larson scores were 91.91±2.29 (group A) and 92.81±2.39 (group B); IKDC scores were 93.89±1.88 (group A) and 94.15±1.77 (group B). None of the scoring differences between groups were statistically significant (T1=0.849, P1=0.399, T2=1.506, P2=0.137, T3=0.560, P3=0.578). The Lachman test was negative in 46 patients (90.2%) and 51 knees, including 25 (89.3%) of the 28 knees in group A and 21 (91.3%) of the 23 knees in group B. Negative Pivot shift was present postoperatively in 49 knees of 51 patients (96.1%), including 27 (96.4%) of the 28 knees in group A and 22 (95.7%) of the 23 knees in group B. All of the patients in both groups achieved full extension and at least 135° of knee flexion. This novel technique involves the creation of double tibial tunnels and a single femoral tunnel. In the tibia, there was a bone bridge, ranging from 2 to 3mm, between the two bundles, which are tensioned at different degrees of flexion to maintain the stability of the knee. In the femur, the grafts were fixed with bioabsorbable interference screws or Endobuttons. The outcomes show that normal function and joint stability were achieved in both groups, as compared with preoperative measurements. Although the outcomes in group A (grafts fixed with the bioabsorbable interference screws in the femur) was better than those observed in group B (grafts fixed with Endobuttons), there was no statistical difference between the groups.