ArticleArthroscopy techniques2025
Augmented Over-The-Top Technique for Revision Anterior Cruciate Ligament Reconstruction.
Article in Arthroscopy techniques, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Revision anterior cruciate ligament reconstruction is technically demanding, particularly in cases with femoral tunnel malposition or tibial tunnel enlargement. The over-the-top (OTT) technique offers a single-stage solution by avoiding femoral tunnel drilling. However, its main limitation is the reduced graft diameter, typically between 5.5 and 7 mm, which may be insufficient in revision settings. This Technical Note describes an augmentation of the classic OTT technique using a peroneus longus tendon allograft wrapped around preserved-insertion hamstring tendons, achieving graft diameters exceeding 8 mm. Standard arthroscopic portals are used to prepare a standard tibial tunnel, whereas a lateral femoral approach is performed to prepare the OTT point. Femoral fixation is secured with staples, and a lateral extra-articular tenodesis is performed to enhance rotational stability. This combined intra- and extra-articular reconstruction allows single-stage revision even in the presence of tunnel enlargement, improving biomechanical strength and potentially accelerating biological integration through preservation of the tibial insertion. The described technique offers a reliable, reproducible, and cost-effective option for complex anterior cruciate ligament revisions.
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