ArticleOrthopaedic journal of sports medicine2022
A Biomechanical Comparison of 2 Over-the-Top Anterior Cruciate Ligament Reconstruction Techniques: A Cadaveric Study Using a Robotic Simulator.
Article in Orthopaedic journal of sports medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 7 citations in OpenAlex.
- Double tibial tunnels 'supra' over-the-top anterior cruciate ligament reconstruction with lower initial graft tension achieves comparable anterior stability to single-tunnel: A cadaveric study using a robotic simulator.Journal of experimental orthopaedics · 2025Article
- Age-specific over-the-top techniques for physeal sparing anterior cruciate ligament (ACL) reconstruction in skeletally immature patients: Current concepts for prepubescents to older adolescents.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- The In Situ Force and Contribution of Each Ligamentous Band of the Deltoid Ligament in Ankle Joint Stability: A Cadaveric Biomechanical Study.Orthopaedic journal of sports medicine · 2025Article
- Dynamic Deformation Behavior of the Porcine Anterior Cruciate Ligament Enthesis Under Anterior Tibial Loading.Annals of biomedical engineering · 2025Article
- Over-The-Top Technique for ACL Reconstruction: Advantages, Disadvantages, and Postoperative Complications.Orthopaedic surgery · 2025Review
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Authors and funding
12 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: For skeletally immature patients, over-the-top (OTT) anterior cruciate ligament (ACL) reconstruction (ACLR) is preferred. However, increased anterior laxity at deep knee flexion angles remains concerning. We modified the procedure to proximally shift the graft fixation site on the femur to prevent graft loosening at higher knee flexion angles and named it the supra-OTT procedure. Purpose: To compare anterior laxity and in situ forces of the ACL graft between conventional OTT and supra-OTT ACLR in a cadaveric model. Study Design: Controlled laboratory study. Methods: A total of 11 fresh-frozen cadaveric knee specimens underwent 4 robotic testing conditions: ACL intact, ACL resected, conventional OTT, and supra-OTT. For each condition, a 100-N load was applied at 0°, 15°, 30°, 60°, and 90° of knee flexion to simulate the Lachman test or anterior drawer test. In addition, a combined load of 5-N·m internal tibial torque and 10-N·m valgus torque was applied at 15° and 30° of knee flexion as a simulated pivot-shift test. Anterior tibial translation and in situ graft forces were recorded. The only difference between conventional OTT and supra-OTT ACLR was the graft fixation site on the femur. For conventional OTT ACLR, graft fixation was performed just on the proximal and lateral ends of the posterior condyle. For supra-OTT ACLR, the fixation point was around the proximal insertion of the lateral head of the gastrocnemius and the lateral edge of the posterior cortex, approximately 2 cm proximal to the conventional OTT position. Results: On the simulated anterior drawer test at 60° and 90° of knee flexion, anterior tibial translation after supra-OTT ACLR was significantly smaller than after conventional OTT ACLR ( Conclusion: Supra-OTT ACLR showed better biomechanical performance to control anterior laxity than conventional OTT ACLR at higher knee flexion angles. Clinical Relevance: The supra-OTT procedure may improve anterior stability at deep knee flexion angles.
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