Over-the-top or tunnel reconstruction of the anterior cruciate ligament? A prospective randomised study of 54 patients

Purpose The aim of the study was to evaluate the “over the top” (OTT) nonanatomical technique for revision of anterior cruciate ligament (ACL) reconstruction. Methods Twenty-four patients with a mean age of 31.9 ± 11.2 years underwent revision of ACL reconstruction using OTT technique. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner score, Subjective Patient Outcome for Return to Sport (SPORTS) score, Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, and KT-1000 evaluation were recorded at a mean follow-up of 30.7 ± 18.9 months. Results Postoperatively, the IKDC objective total score significantly improved (p = 0.0046). The KOOS, Lysholm, and Tegner scores also improved, but the results were not statistically significant (62.4 vs. 72.6, 6.5 vs. 75.8, and 4.1 vs. 6.0, respectively). The subjective IKDC evaluation score improved from an average of 51.1 points to 63.7 points at the last follow-up (p = 0.0027). The RTP prevalence was 81.8%, with 44.4% of the patients returning to the same preinjury level. According to the SPORTS score, 16.6% of patients played sport without limitations in activity and performance. The average ACL-RSI score was 52.1 ± 27.0. No major complications were reported. A total of 21.5% of patients underwent surgical removal of staples. The failure prevalence was 14.3% and the cumulative survivorship, calculated using the Kaplan–Meier method, was equal to 70% at 60 months of follow-up. Conclusion The OTT technique in the revision ACL reconstruction provided improvement in objective and subjective scores, good RTP prevalence, and acceptable rate of complication and failure. One of the advantages was the possibility to avoid the femoral tunnel. Level of Evidence Level IV, therapeutic case series.

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Effectiveness comparison of over-the top position and anatomical central position single-bundle reconstruction of anterior cruciate ligament

Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology ◽

10.1016/j.asmart.2017.05.177 ◽

2017 ◽

Vol 9 ◽

pp. 81

Author(s):

Chen Chongmin ◽

Sun Yu

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Central Position ◽

Single Bundle ◽

Anterior Cruciate ◽

Over The Top

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In vitro comparison of over-the-top and through-the-condyle anterior cruciate ligament reconstructions

The American Journal of Sports Medicine ◽

10.1177/036354659202000514 ◽

1992 ◽

Vol 20 (5) ◽

pp. 567-574 ◽

Cited By ~ 23

Author(s):

Richard S. Brower ◽

Arne Melby ◽

Michael J. Askew ◽

Donald C. Beringer

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Anterior Cruciate ◽

Over The Top ◽

In Vitro Comparison

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A Comparative Study of the Length Patterns of Anterior Cruciate Ligament Reconstructions in the Dog and Man

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632634 ◽

2000 ◽

Vol 13 (02) ◽

pp. 73-77 ◽

Cited By ~ 7

Author(s):

J. T. Andrish ◽

M. L. Olmstead ◽

Helen Kambic ◽

A. Shah ◽

M. P. Palmisano

Keyword(s):

Anterior Cruciate Ligament ◽

Soft Tissues ◽

Cruciate Ligament ◽

Statistical Significance ◽

Full Extension ◽

Cranial Cruciate Ligament ◽

Custom Made ◽

Fresh Frozen ◽

Anterior Cruciate ◽

Over The Top

SummaryTo measure the change of length patterns of nine different simulated anterior cruciate ligament (ACL) reconstructions in the canine and human knee.Six fresh-frozen canine cadaver knees and six fresh-frozen human cadaver knees were used in this study. All of the soft tissues were removed from each cadaver knee, leaving the menisci, collateral ligaments and cruciate ligaments intact. After fixation of the femur to a custom-made frame, the ACL was excised. Three tunnels were made each at the ACL origin and insertion, making possible nine reconstruction combinations. A modified intra-articular technique was used to measure change of length, in mm, of each ACL reconstruction through a range of motion of 0 degrees (full extension) to 135 degrees of flexion. A rankorder list of reconstruction combinations was determined. The most isometric combination was determined for the canine and human knees, and trends in length patterns were also evaluated in both species relative to femoral and tibial position. Statistical significance was determined by ANOVA.A combination joining a point caudal to the ACL origin (over-the-top) and anterior on the tibial insertion was found to be the most isometric combination in both the canine and human. The trends in change of length patterns across all reconstruction combinations were similar in the dog and man. Isometry was improved as the reconstruction was placed further posterior on the femur and anterior on the tibia. Conclusions: The canine knee is an appropriate animal model for the study of isometry of the human ACL and its reconstructions.The length patterns of nine simulated Anterior Cruciate Ligament (ACL) reconstructions were determined in the dog and man. In both species, the most isometric reconstruction was one joining points corresponding to a position at the posterior edge of the intercondylar roof of the femur (over-thetop) with a position anterior on the ACL insertion. For the sake of clarity the term anterior cruciate ligament has been used, throughout, for both species, instead of the cranial cruciate ligament (CCL) in the dog. Also knee has been used in place of stifle for the dog.

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Over-the-top Anterior Cruciate Ligament (ACL) reconstruction plus lateral plasty with hamstrings in high-school athletes: Results at 10 years

The Knee ◽

10.1016/j.knee.2021.10.004 ◽

2021 ◽

Vol 33 ◽

pp. 226-233

Author(s):

Alberto Grassi ◽

Nicola Pizza ◽

Luca Macchiarola ◽

Gian Andrea Lucidi ◽

Federico Stefanelli ◽

...

Keyword(s):

High School ◽

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

High School Athletes ◽

Anterior Cruciate ◽

Over The Top

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The Relationship of the Femoral Origin of the Anterior Cruciate Ligament and the Distal Femoral Physeal Plate in the Skeletally Immature Knee

The American Journal of Sports Medicine ◽

10.1177/03635465010290061801 ◽

2001 ◽

Vol 29 (6) ◽

pp. 781-787 ◽

Cited By ~ 80

Author(s):

Christopher T. Behr ◽

Hollis G. Potter ◽

George A. Paletta

Keyword(s):

Anterior Cruciate Ligament ◽

Sagittal Plane ◽

Cruciate Ligament ◽

Spatial Relationship ◽

Skeletally Immature ◽

Proliferative Zone ◽

Anterior Cruciate ◽

Femoral Physis ◽

Relationship Of ◽

Over The Top

We defined the anatomic relationship of the anterior cruciate ligament femoral origin to the distal femoral physis in the skeletally immature knee with use of 12 fresh-frozen human fetal specimens (ages, 20 to 36 weeks). Each specimen underwent magnetic resonance imaging, was dissected free of soft tissue, sectioned in the sagittal plane, and stained. The spatial relationship of 1) the epiphyseal side of the physeal proliferative zone to the nearest point of bony attachment of the anterior cruciate ligament and 2) the origin of the anterior cruciate ligament to the over-the-top position were measured. The same measurements were made in 13 skeletally immature knees (ages, 5 to 15 years). We found that the femoral origin of the fetal anterior cruciate ligament developed as a confluence of ligament fibers with periosteum at 20 weeks, vascular invasion into the epiphysis at 24 weeks, and establishment of a secure epiphyseal attachment by 36 weeks. In the fetus, the distance from the anterior cruciate ligament femoral origin to the epiphysis was 2.66 ± 0.18 mm (range, 2.34 to 2.94). There was no significant change in this distance in adolescent specimens (2.92 ± 0.68 mm; range, 2.24 to 3.62). The over-the-top position was at the level of the distal femoral physis.

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