Augmented Over-The-Top Technique for Revision Anterior Cruciate Ligament Reconstruction

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomedical Engineering

Background:

• Revision anterior cruciate ligament (ACL) reconstruction presents significant technical challenges, especially with prior tunnel malposition or enlargement.
• The standard over-the-top (OTT) technique simplifies femoral tunnel creation but often results in a graft diameter insufficient for revision cases.

Purpose of the Study:

• To describe an augmented over-the-top (OTT) technique for revision ACL reconstruction.
• To achieve a larger graft diameter ( > 8 mm) suitable for complex revision settings.

Main Methods:

• Augmentation of the classic OTT technique using a peroneus longus tendon allograft wrapped around hamstring tendons.
• Utilized standard arthroscopic portals for tibial tunnel preparation and a lateral femoral approach for the OTT point.
• Employed femoral fixation with staples and a lateral extra-articular tenodesis for enhanced rotational stability.

Main Results:

• Achieved graft diameters exceeding 8 mm, addressing the limitation of the standard OTT technique.
• Enabled single-stage revision surgery even with existing tunnel enlargement.
• Combined intra- and extra-articular reconstruction potentially improves biomechanical strength and biological integration.

Conclusions:

• The described augmented OTT technique provides a reliable, reproducible, and cost-effective solution for complex ACL revisions.
• Preservation of the tibial insertion may accelerate biological integration.
• This approach enhances graft diameter and rotational stability in revision ACL surgery.