Equivalent outcomes of ACL revision with over-the-top single and double-bundle reconstruction using hamstring tendon compared to anatomical single and double-bundle reconstruction

Abstract

Purpose In revision anterior cruciate ligament reconstruction (ACLR), our procedure of choice is the over-the-top route (OTTR) for cases where it is difficult to use a primary bone tunnel or to create a new bone tunnel due to the enlargement or malposition of the bone tunnel. Depending on the condition of the primary bone tunnel, we choose single (bone tunnel or OTTR) or double (bone tunnel or anteromedial (AM) bundle: OTTR /posterolateral (PL) bundle: bone tunnel) for femoral fixation. This study showed the results of single and double OTTR revision ACLR using the hamstring tendon. Methods Seventy-eight patients, who underwent revision ACLR using the hamstring tendon and who could be followed up for more than 2 year, were included in this study. The methods of revision ACLR were single in 54 cases (bone tunnel: 24 cases; OTTR method: 30 cases) and double in 24 cases (bone tunnel: 16 cases; OTTR for AM bundle and bone tunnel for PL bundle: eight cases). The cause of re-injury, the meniscus and cartilage injury, the reconstruction method, and the Lysholm score, Lachman test, Pivot-shift test, and the side-to-side difference in the tibial anterior translation were evaluated before and after surgery. Results There was no statistically significant difference in the Lyshom score, Lachman / Pivotshift test and side-to-side difference anterior translation of the tibia between the four groups. Conclusions The clinical results of single and double OTTR revision ACLR are equivalent to those of anatomic single and double bone tunnel procedures.

Revision Anterior Cruciate Ligament Reconstruction with Over-the-top Augmentation Technique Using an Achilles Tendon Allograft for Enhanced Rotational Stability

“…Over-the-top xation was rst introduced by MacIntosh, and modi cations, such as additional lateral plasty [19] or non-anatomic double bundle reconstruction [20] have been attempted. In biomechanical studies [11,12], over-the-top xation ACL reconstruction showed similar instability to single-bundle anatomical ACL reconstruction, and clinical results [13,14] showed comparable outcomes in primary or revision settings. In addition, over-the-top xation has been veri ed for a long-term outcome of more than 10 years [19,21].…”

“…More recent clinical studies [13,14] have shown that equivalent clinical outcomes are anticipated in both over-the-top and traditional ACL reconstruction techniques in primary and revision settings.…”

Slope-Reducing High Tibial Osteotomy and Over-The-Top Anterior Cruciate Ligament Reconstruction With Achilles Tendon Allograft in Multiple Failed Anterior Cruciate Ligament Reconstruction

“…Graft failure following revision ACL-R using the OTT technique has been reported to be 8.4%, with a 52% rate of return to pre-injury activity levels. 22 Moreover, the OTT route combined with an LET restores rotatory knee laxity in both patients who are skeletally immature and patients undergoing revision ACL-R 23 and yields clinical outcomes comparable to single- and double-bundle revision ACL-R. 24 …”

Over-The-Top Technique for Revision ACL Reconstruction with Achilles Allograft and Associated Lateral Extra-articular Tenodesis

“…Beyond a delayed recovery and risks inherent to a second surgery, the patient is vulnerable to developing additional intra-articular injuries due to residual knee instability during this time period. 5 Application of the OTT technique in a revision setting provides a versatile alternative to traditional approaches and has been shown to have a 52% rate of return to preinjury levels of sport, an 8.4% failure rate, 6 and functional outcomes equivalent to those of anatomic single-and doublebundle revision ACL-R. 7 Despite the existing controversy regarding the use of extra-articular augmentation concurrent to ACL-R, revision patients with a high-grade pivot shift and a predisposition to graft failure may benefit from the addition of LET. 8 A prospective study investigating the use of the OTT approach in combination with LET demonstrated favorable long-term clinical outcomes in 86% of patients.…”

“…Beyond a delayed recovery and risks inherent to a second surgery, the patient is vulnerable to developing additional intra-articular injuries due to residual knee instability during this time period. 5 Application of the OTT technique in a revision setting provides a versatile alternative to traditional approaches and has been shown to have a 52% rate of return to preinjury levels of sport, an 8.4% failure rate, 6 and functional outcomes equivalent to those of anatomic single- and double-bundle revision ACL-R. 7 …”