Research progress of anterior cruciate ligament reconstruction with over-the-top technique_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MEI Sen , LI Ruixin , XIANG Xianxiang ,  WANG Weiming

Department of Sports Medicine, Affiliated Xinhua Hospital of Dalian University, Dalian Liaoning, 116021, P. R. China;

Corresponding author：

WANG Weiming, Email: oldpal@126.com

Keywords：

Anterior cruciate ligament; reconstruction; over-the-top technique

DOI：

10.7507/1002-1892.202203097

Video：

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Objective To review the research progress regarding the over-the-top technique for anterior cruciate ligament (ACL) reconstruction. Methods The relevant literature on ACL reconstruction using the over-the-top technique was analyzed for its evolution, clinical application, advantages, and limitations. Results Over-the-top technique for ACL reconstruction is a combined intra- and extra-articular technique. Because it avoids drilling the femoral tunnel, its advantages are mainly highlighted in the protection of the femur. Therefore, it is widely used in children and adolescents with epiphyseal occlusion and in patients with revision reconstruction. In addition, significant improvements in postoperative joint stability, functional scores, and return to exercise rates are found in long-term follow-up studies of patients with primary ACL reconstruction and combined anterolateral tenodesis. However, the technique also has some limitations, such as poor stability of knee flexion after operation, high requirement for graft length, and easy impact of graft in the intercondylar fossa. Conclusion The current research results show the effectiveness and safety of the over-the-top technique for primary and revision ACL reconstruction, with the advantages of wide application, simple operation, and quick recovery; however, more researches are needed to further optimize the selection of grafts and femoral condyle management problems, and to clarify the long-term effectiveness.

Citation： MEI Sen, LI Ruixin, XIANG Xianxiang, WANG Weiming. Research progress of anterior cruciate ligament reconstruction with over-the-top technique. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(9): 1166-1171. doi: 10.7507/1002-1892.202203097 Copy

1.	李光磊, 王宝鹏, 张汉宽, 等. 前交叉韧带解剖学研究进展. 中国矫形外科杂志, 2021, 29(16): 1491-1495.
2.	Beaulieu ML, Ashton-Miller JA, Wojtys EM. Loading mechanisms of the anterior cruciate ligament. Sports Biomech, 2021. doi: 10.1080/14763141.2021.1916578.
3.	Boden BP, Sheehan FT. Mechanism of non-contact ACL injury: OREF Clinical Research Award 2021. J Orthop Res, 2022, 40(3): 531-540.
4.	Della Villa F, Buckthorpe M, Grassi A, et al. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. Br J Sports Med, 2020, 54(23): 1423-1432.
5.	Matar HE, Platt SR, Bloch BV, et al. A systematic review of randomized controlled trials in anterior cruciate ligament reconstruction: Standard techniques are comparable (299 trials with 25, 816 patients). Arthrosc Sports Med Rehabil, 2021, 3(4): e1211-e1226.
6.	Mitsou A, Vallianatos P, Piskopakis N, et al. Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. J Bone Joint Surg (Br), 1990, 72(3): 398-404.
7.	Gidumal R. Combined anterior cruciate-ligament reconstruction using semitendinosus tendon and iliotibial tract. J Bone Joint Surg (Am), 1986, 68(6): 952-953.
8.	Usman MA, Kamei G, Adachi N, et al. Revision single-bundle anterior cruciate ligament reconstruction with over-the-top route procedure. Orthop Traumatol Surg Res, 2015, 101(1): 71-75.
9.	Amis AA, Camburn M, Kempson SA, et al. Anterior cruciate ligament replacement with polyester fibre. A long-term study of tissue reactions and joint stability in sheep. J Bone Joint Surg (Br), 1992, 74(4): 605-613.
10.	Muneta T, Yamamoto H, Sakai H, et al. Relationship between changes in length and force in in vitro reconstructed anterior cruciate ligament. Am J Sports Med, 1993, 21(2): 299-304.
11.	Melhorn JM, Henning CE. The relationship of the femoral attachment site to the isometric tracking of the anterior cruciate ligament graft. Am J Sports Med, 1987, 15(6): 539-542.
12.	Penner DA, Daniel DM, Wood P, et al. An in vitro study of anterior cruciate ligament graft placement and isometry. Am J Sports Med, 1988, 16(3): 238-243.
13.	Wong SE, Feeley BT, Pandya NK. Comparing outcomes between the over-the-top and all-epiphyseal techniques for physeal-sparing acl reconstruction: A narrative review. Orthop J Sports Med, 2019, 7(3): 2325967119833689. doi: 10.1177/2325967119833689.
14.	Grassi A, Macchiarola L, Lucidi GA, et al. Ten-year survivorship, patient-reported outcome measures, and patient acceptable symptom state after over-the-top hamstring anterior cruciate ligament reconstruction with a lateral extra-articular reconstruction: Analysis of 267 consecutive cases. Am J Sports Med, 2021, 49(2): 374-383.
15.	Grassi A, Pizza N, Macchiarola L, et al. Over-the-top anterior cruciate ligament (ACL) reconstruction plus lateral plasty with hamstrings in high-school athletes: Results at 10 years. Knee, 2021, 33: 226-233.
16.	Lanzetti RM, Pace V, Ciompi A, et al. Over the top anterior cruciate ligament reconstruction in patients with open physes: a long-term follow-up study. Int Orthop, 2020, 44(4): 771-778.
17.	James EW, Dawkins BJ, Schachne JM, et al. Early operative versus delayed operative versus nonoperative treatment of pediatric and adolescent anterior cruciate ligament injuries: A systematic review and meta-analysis. Am J Sports Med, 2021, 49(14): 4008-4017.
18.	Demange MK, Camanho GL. Nonanatomic anterior cruciate ligament reconstruction with double-stranded semitendinosus grafts in children with open physes: minimum 15-year follow-up. Am J Sports Med, 2014, 42(12): 2926-2932.
19.	Mariscalco MW, Flanigan DC, Mitchell J, et al. The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study. Arthroscopy, 2013, 29(12): 1948-1953.
20.	Nagai K, Rothrauff BB, Li RT, et al. Over-the-top ACL reconstruction restores anterior and rotatory knee laxity in skeletally immature individuals and revision settings. Knee Surg Sports Traumatol Arthrosc, 2020, 28(2): 538-543.
21.	Roberti di Sarsina T, Macchiarola L, Signorelli C, et al. Anterior cruciate ligament reconstruction with an all-epiphyseal “over-the-top” technique is safe and shows low rate of failure in skeletally immature athletes. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 498-506.
22.	Yiannakopoulos CK, Fules PJ, Korres DS, et al. Revision anterior cruciate ligament surgery using the over-the-top femoral route. Arthroscopy, 2005, 21(2): 243-247.
23.	Marcacci M, Zaffagnini S, Bonanzinga T, et al. Over-the-top double-bundle revision ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(7): 1404-1408.
24.	Buda R, Ruffilli A, Di Caprio F, et al. Allograft salvage procedure in multiple-revision anterior cruciate ligament reconstruction. Am J Sports Med, 2013, 41(2): 402-410.
25.	Ruffilli A, Buda R, Pagliazzi G, et al. Over-the-top anterior cruciate ligament reconstruction using single- or double-strand hamstrings autograft. Orthopedics, 2015, 38(7): e635-e643.
26.	Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. Anterior cruciate ligament revision with Achilles tendon allograft in young athletes. Orthop Traumatol Surg Res, 2018, 104(2): 209-215.
27.	Sarraj M, de Sa D, Shanmugaraj A, et al. Over-the-top ACL reconstruction yields comparable outcomes to traditional ACL reconstruction in primary and revision settings: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 427-444.
28.	Fayard JM, Sonnery-Cottet B, Vrgoc G, et al. Incidence and risk factors for a partial anterior cruciate ligament tear progressing to a complete tear after nonoperative treatment in patients younger than 30 years. Orthop J Sports Med, 2019, 7(7): 2325967119856624. doi: 10.1177/2325967119856624.
29.	Koc BB, Jansen EJP, van Dijk P, et al. Mechanoreceptors observed in a ligamentous structure between the posterior horn of the lateral meniscus and the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc, 2021, 29(6): 1701-1708.
30.	Serrano-Fernandez JM, Espejo-Baena A, Martin-Castilla B, et al. Augmentation technique for partial ACL ruptures using semitendinosus tendon in the over-the-top position. Knee Surg Sports Traumatol Arthrosc, 2010, 18(9): 1214-1218.
31.	Buda R, Ruffilli A, Parma A, et al. Partial ACL tears: anatomic reconstruction versus nonanatomic augmentation surgery. Orthopedics, 2013, 36(9): e1108-e1113.
32.	Galway HR, Beaupré A, Macintosh DL. Pivot shift: a clinical sign of symptomatic anterior cruciate insufficiency. J Bone Joint Surg (Br), 1972, 54: 763-764.
33.	Hughston JC, Andrews JR, Cross MJ, et al. Classification of knee ligament instabilities. Part Ⅱ. The lateral compartment. J Bone Joint Surg (Am), 1976, 58(2): 173-179.
34.	Tanaka M, Vyas D, Moloney G, et al. What does it take to have a high-grade pivot shift? Knee Surg Sports Traumatol Arthrosc, 2012, 20(4): 737-742.
35.	Xu J, Han K, Lee TQ, et al. Anterolateral structure reconstruction similarly improves the stability and causes less overconstraint in anterior cruciate ligament-reconstructed knees compared with modified lemaire lateral extra-articular tenodesis: A biomechanical study. Arthroscopy, 2022, 38(3): 911-924.
36.	Ueki H, Katagiri H, Otabe K, et al. Contribution of additional anterolateral structure augmentation to controlling pivot shift in anterior cruciate ligament reconstruction. Am J Sports Med, 2019, 47(9): 2093-2101.
37.	Porter MD, Shadbolt B, Pomroy S. The augmentation of revision anterior cruciate ligament reconstruction with modified iliotibial band tenodesis to correct the pivot shift: A computer navigation study. Am J Sports Med, 2018, 46(4): 839-845.
38.	Getgood AMJ, Bryant DM, Litchfield R, et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-year outcomes from the stability study randomized clinical trial. Am J Sports Med, 2020, 48(2): 285-297.
39.	Marcacci M, Zaffagnini S, Giordano G, et al. Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: A prospective clinical and radiographic evaluation with 10- to 13-year follow-up. Am J Sports Med, 2009, 37(4): 707-714.
40.	Marcacci M, Zaffagnini S, Iacono F, et al. Intra- and extra-articular anterior cruciate ligament reconstruction utilizing autogeneous semitendinosus and gracilis tendons: 5-year clinical results. Knee Surg Sports Traumatol Arthrosc, 2003, 11(1): 2-8.
41.	Zaffagnini S, Signorelli C, Lopomo N, et al. Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: an in vivo quantitative assessment of knee laxity in two different ACL reconstructions. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1): 153-159.
42.	Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, et al. Over-the-top ACL reconstruction plus extra-articular lateral tenodesis with hamstring tendon grafts: prospective evaluation with 20-year minimum follow-up. Am J Sports Med, 2017, 45(14): 3233-3242.
43.	Lee DH, Kim HJ, Ahn HS, et al. Comparison of femur tunnel aperture location in patients undergoing transtibial and anatomical single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2016, 24(12): 3713-3721.
44.	Iriuchishima T, Tajima G, Ingham SJ, et al. PCL to graft impingement pressure after anatomical or non-anatomical single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 964-969.
45.	Pennock AT, Ho B, Parvanta K, et al. Does allograft augmentation of small-diameter hamstring autograft acl grafts reduce the incidence of graft retear? Am J Sports Med, 2017, 45(2): 334-338.
46.	Winkler PW, Wagala NN, Hughes JD, et al. A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures. Knee Surg Sports Traumatol Arthrosc, 2022, 30(1): 139-148.

1. 李光磊, 王宝鹏, 张汉宽, 等. 前交叉韧带解剖学研究进展. 中国矫形外科杂志, 2021, 29(16): 1491-1495.
2. Beaulieu ML, Ashton-Miller JA, Wojtys EM. Loading mechanisms of the anterior cruciate ligament. Sports Biomech, 2021. doi: 10.1080/14763141.2021.1916578.
3. Boden BP, Sheehan FT. Mechanism of non-contact ACL injury: OREF Clinical Research Award 2021. J Orthop Res, 2022, 40(3): 531-540.
4. Della Villa F, Buckthorpe M, Grassi A, et al. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. Br J Sports Med, 2020, 54(23): 1423-1432.
5. Matar HE, Platt SR, Bloch BV, et al. A systematic review of randomized controlled trials in anterior cruciate ligament reconstruction: Standard techniques are comparable (299 trials with 25, 816 patients). Arthrosc Sports Med Rehabil, 2021, 3(4): e1211-e1226.
6. Mitsou A, Vallianatos P, Piskopakis N, et al. Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. J Bone Joint Surg (Br), 1990, 72(3): 398-404.
7. Gidumal R. Combined anterior cruciate-ligament reconstruction using semitendinosus tendon and iliotibial tract. J Bone Joint Surg (Am), 1986, 68(6): 952-953.
8. Usman MA, Kamei G, Adachi N, et al. Revision single-bundle anterior cruciate ligament reconstruction with over-the-top route procedure. Orthop Traumatol Surg Res, 2015, 101(1): 71-75.
9. Amis AA, Camburn M, Kempson SA, et al. Anterior cruciate ligament replacement with polyester fibre. A long-term study of tissue reactions and joint stability in sheep. J Bone Joint Surg (Br), 1992, 74(4): 605-613.
10. Muneta T, Yamamoto H, Sakai H, et al. Relationship between changes in length and force in in vitro reconstructed anterior cruciate ligament. Am J Sports Med, 1993, 21(2): 299-304.
11. Melhorn JM, Henning CE. The relationship of the femoral attachment site to the isometric tracking of the anterior cruciate ligament graft. Am J Sports Med, 1987, 15(6): 539-542.
12. Penner DA, Daniel DM, Wood P, et al. An in vitro study of anterior cruciate ligament graft placement and isometry. Am J Sports Med, 1988, 16(3): 238-243.
13. Wong SE, Feeley BT, Pandya NK. Comparing outcomes between the over-the-top and all-epiphyseal techniques for physeal-sparing acl reconstruction: A narrative review. Orthop J Sports Med, 2019, 7(3): 2325967119833689. doi: 10.1177/2325967119833689.
14. Grassi A, Macchiarola L, Lucidi GA, et al. Ten-year survivorship, patient-reported outcome measures, and patient acceptable symptom state after over-the-top hamstring anterior cruciate ligament reconstruction with a lateral extra-articular reconstruction: Analysis of 267 consecutive cases. Am J Sports Med, 2021, 49(2): 374-383.
15. Grassi A, Pizza N, Macchiarola L, et al. Over-the-top anterior cruciate ligament (ACL) reconstruction plus lateral plasty with hamstrings in high-school athletes: Results at 10 years. Knee, 2021, 33: 226-233.
16. Lanzetti RM, Pace V, Ciompi A, et al. Over the top anterior cruciate ligament reconstruction in patients with open physes: a long-term follow-up study. Int Orthop, 2020, 44(4): 771-778.
17. James EW, Dawkins BJ, Schachne JM, et al. Early operative versus delayed operative versus nonoperative treatment of pediatric and adolescent anterior cruciate ligament injuries: A systematic review and meta-analysis. Am J Sports Med, 2021, 49(14): 4008-4017.
18. Demange MK, Camanho GL. Nonanatomic anterior cruciate ligament reconstruction with double-stranded semitendinosus grafts in children with open physes: minimum 15-year follow-up. Am J Sports Med, 2014, 42(12): 2926-2932.
19. Mariscalco MW, Flanigan DC, Mitchell J, et al. The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) cohort study. Arthroscopy, 2013, 29(12): 1948-1953.
20. Nagai K, Rothrauff BB, Li RT, et al. Over-the-top ACL reconstruction restores anterior and rotatory knee laxity in skeletally immature individuals and revision settings. Knee Surg Sports Traumatol Arthrosc, 2020, 28(2): 538-543.
21. Roberti di Sarsina T, Macchiarola L, Signorelli C, et al. Anterior cruciate ligament reconstruction with an all-epiphyseal “over-the-top” technique is safe and shows low rate of failure in skeletally immature athletes. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 498-506.
22. Yiannakopoulos CK, Fules PJ, Korres DS, et al. Revision anterior cruciate ligament surgery using the over-the-top femoral route. Arthroscopy, 2005, 21(2): 243-247.
23. Marcacci M, Zaffagnini S, Bonanzinga T, et al. Over-the-top double-bundle revision ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(7): 1404-1408.
24. Buda R, Ruffilli A, Di Caprio F, et al. Allograft salvage procedure in multiple-revision anterior cruciate ligament reconstruction. Am J Sports Med, 2013, 41(2): 402-410.
25. Ruffilli A, Buda R, Pagliazzi G, et al. Over-the-top anterior cruciate ligament reconstruction using single- or double-strand hamstrings autograft. Orthopedics, 2015, 38(7): e635-e643.
26. Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. Anterior cruciate ligament revision with Achilles tendon allograft in young athletes. Orthop Traumatol Surg Res, 2018, 104(2): 209-215.
27. Sarraj M, de Sa D, Shanmugaraj A, et al. Over-the-top ACL reconstruction yields comparable outcomes to traditional ACL reconstruction in primary and revision settings: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2019, 27(2): 427-444.
28. Fayard JM, Sonnery-Cottet B, Vrgoc G, et al. Incidence and risk factors for a partial anterior cruciate ligament tear progressing to a complete tear after nonoperative treatment in patients younger than 30 years. Orthop J Sports Med, 2019, 7(7): 2325967119856624. doi: 10.1177/2325967119856624.
29. Koc BB, Jansen EJP, van Dijk P, et al. Mechanoreceptors observed in a ligamentous structure between the posterior horn of the lateral meniscus and the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc, 2021, 29(6): 1701-1708.
30. Serrano-Fernandez JM, Espejo-Baena A, Martin-Castilla B, et al. Augmentation technique for partial ACL ruptures using semitendinosus tendon in the over-the-top position. Knee Surg Sports Traumatol Arthrosc, 2010, 18(9): 1214-1218.
31. Buda R, Ruffilli A, Parma A, et al. Partial ACL tears: anatomic reconstruction versus nonanatomic augmentation surgery. Orthopedics, 2013, 36(9): e1108-e1113.
32. Galway HR, Beaupré A, Macintosh DL. Pivot shift: a clinical sign of symptomatic anterior cruciate insufficiency. J Bone Joint Surg (Br), 1972, 54: 763-764.
33. Hughston JC, Andrews JR, Cross MJ, et al. Classification of knee ligament instabilities. Part Ⅱ. The lateral compartment. J Bone Joint Surg (Am), 1976, 58(2): 173-179.
34. Tanaka M, Vyas D, Moloney G, et al. What does it take to have a high-grade pivot shift? Knee Surg Sports Traumatol Arthrosc, 2012, 20(4): 737-742.
35. Xu J, Han K, Lee TQ, et al. Anterolateral structure reconstruction similarly improves the stability and causes less overconstraint in anterior cruciate ligament-reconstructed knees compared with modified lemaire lateral extra-articular tenodesis: A biomechanical study. Arthroscopy, 2022, 38(3): 911-924.
36. Ueki H, Katagiri H, Otabe K, et al. Contribution of additional anterolateral structure augmentation to controlling pivot shift in anterior cruciate ligament reconstruction. Am J Sports Med, 2019, 47(9): 2093-2101.
37. Porter MD, Shadbolt B, Pomroy S. The augmentation of revision anterior cruciate ligament reconstruction with modified iliotibial band tenodesis to correct the pivot shift: A computer navigation study. Am J Sports Med, 2018, 46(4): 839-845.
38. Getgood AMJ, Bryant DM, Litchfield R, et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-year outcomes from the stability study randomized clinical trial. Am J Sports Med, 2020, 48(2): 285-297.
39. Marcacci M, Zaffagnini S, Giordano G, et al. Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: A prospective clinical and radiographic evaluation with 10- to 13-year follow-up. Am J Sports Med, 2009, 37(4): 707-714.
40. Marcacci M, Zaffagnini S, Iacono F, et al. Intra- and extra-articular anterior cruciate ligament reconstruction utilizing autogeneous semitendinosus and gracilis tendons: 5-year clinical results. Knee Surg Sports Traumatol Arthrosc, 2003, 11(1): 2-8.
41. Zaffagnini S, Signorelli C, Lopomo N, et al. Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: an in vivo quantitative assessment of knee laxity in two different ACL reconstructions. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1): 153-159.
42. Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, et al. Over-the-top ACL reconstruction plus extra-articular lateral tenodesis with hamstring tendon grafts: prospective evaluation with 20-year minimum follow-up. Am J Sports Med, 2017, 45(14): 3233-3242.
43. Lee DH, Kim HJ, Ahn HS, et al. Comparison of femur tunnel aperture location in patients undergoing transtibial and anatomical single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2016, 24(12): 3713-3721.
44. Iriuchishima T, Tajima G, Ingham SJ, et al. PCL to graft impingement pressure after anatomical or non-anatomical single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2012, 20(5): 964-969.
45. Pennock AT, Ho B, Parvanta K, et al. Does allograft augmentation of small-diameter hamstring autograft acl grafts reduce the incidence of graft retear? Am J Sports Med, 2017, 45(2): 334-338.
46. Winkler PW, Wagala NN, Hughes JD, et al. A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures. Knee Surg Sports Traumatol Arthrosc, 2022, 30(1): 139-148.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress of anterior cruciate ligament reconstruction with over-the-top technique

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