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Over-the-top ACL reconstruction restores anterior and rotatory knee laxity in skeletally immature individuals and revision settings

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the objective outcomes following anterior cruciate ligament reconstruction (ACLR) with the over-the-top (OTT) technique.

Methods

Thirty-five ACL-deficient patients with mean follow-up of 2.2 years were retrospectively reviewed. This included 14 skeletally immature individuals (age: 14 ± 1 years) who underwent primary OTT ACLR (adolescent group) and 21 skeletally mature individuals (age: 25 ± 8 years) who underwent OTT revision ACLR (revision group). The tibial tunnel was created at the anatomic position for all cases. No lateral extra-articular tenodesis was performed. Before and after surgery, the side-to-side difference (SSD) in anterior laxity was measured using KT-1000 arthrometer. Lachman and pivot-shift tests were assessed according to IKDC grade. The graft failure rate was assessed.

Results

The post-operative SSD in anterior laxity was significantly reduced in the adolescent (pre-op, 3.9 ± 1.8 mm; post-op, 1.2 ± 0.8 mm; p = 0.040) and revision groups (pre-op, 4.2 ± 1.7 mm; post-op, 1.2 ± 1.4 mm; p < 0.001). Postoperative knee laxity measured by Lachman and pivot-shift tests were also significantly improved in both groups. Graft rupture occurred in two patients in the adolescent group (14.3%), and one patient in the revision group (4.8%).

Conclusion

ACLR with the OTT technique restored anterior and rotatory knee laxity in skeletally immature individuals and in revision settings. This one-step procedure may be a good option for skeletally immature individuals and revision settings.

Level of evidence

IV.

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References

  1. Amano H, Toritsuka Y, Uchida R, Mae T, Ohzono K et al (2015) Outcome of anatomical double-bundle ACL reconstruction using hamstring tendons via an outside-in approach. Knee Surg Sport Traumatol Arthrosc 23:1222–1230

    Article  Google Scholar 

  2. Andrews M, Noyes F, Barber-Westin SD (1994) Anterior cruciate ligament allograft reconstruction in the skeletally immature athlete. Am J Sports Med 22:48–54

    Article  CAS  Google Scholar 

  3. Araujo PH, van Eck CF, Macalena JA, Fu FH (2011) Advances in the three-portal technique for anatomical single- or double-bundle ACL reconstruction. Knee Surg Sport Traumatol Arthrosc 19:1239–1242

    Article  Google Scholar 

  4. Asai S, Maeyama A, Hoshino Y, Goto B, Celentano U et al (2014) A comparison of dynamic rotational knee instability between anatomic single-bundle and over-the-top anterior cruciate ligament reconstruction using triaxial accelerometry. Knee Surg Sport Traumatol Arthrosc 22:972–978

    Article  Google Scholar 

  5. Buda R, Ruffilli A, Di Caprio F, Ferruzzi A, Faldini C et al (2013) Allograft salvage procedure in multiple-revision anterior cruciate ligament reconstruction. Am J Sports Med 41:402–410

    Article  Google Scholar 

  6. Defrancesco CJ, Storey EP, Shea KG, Kocher MS, Ganley TJ (2018) Challenges in the management of anterior cruciate ligament ruptures in skeletally immature patients. J Am Acad Orthop Surg 26:e50–e61

    Article  Google Scholar 

  7. Demange MK, Camanho GL (2014) Nonanatomic anterior cruciate ligament reconstruction with double-stranded semitendinosus grafts in children with open physes: minimum 15-year follow-up. Am J Sports Med 42:2926–2932

    Article  Google Scholar 

  8. Fujita N, Kuroda R, Matsumoto T, Yamaguchi M, Yagi M et al (2011) Comparison of the clinical outcome of double-bundle, anteromedial single-bundle, and posterolateral single-bundle anterior cruciate ligament reconstruction using hamstring tendon graft with minimum 2-year follow-up. Arthroscopy 27:906–913

    Article  Google Scholar 

  9. Gabler CM, Jacobs CA, Howard JS, Mattacola CG, Johnson DL (2015) Comparison of graft failure rate between autografts placed via an anatomic anterior cruciate ligament reconstruction technique. Am J Sports Med 44:1069–1079

    Article  Google Scholar 

  10. Ho B, Edmonds EW, Chambers HG, Bastrom TP, Pennock AT (2018) Risk factors for early ACL reconstruction failure in pediatric and adolescent patients. J Pediatr Orthop 38:388–392

    Article  Google Scholar 

  11. Irrgang J, Enseki K (2008) Rehabilitation following ACL reconstruction. In Fu F, Cohen S (eds) Current concepts in ACL reconstruction SLACK, Thorofare, pp NJ377–390

  12. Jonsson H, Elmqvist LG, Karrholm J, Tegner Y (1994) Over-the-top or tunnel reconstruction of the anterior cruciate ligament? A prospective randomised study of 54 patients. J Bone Jt Surg Br 76:82–87

    Article  CAS  Google Scholar 

  13. Karlson JA, Steiner ME, Brown CH, Johnston J (1994) Anterior cruciate ligament reconstruction using gracilis and semitendinosus tendons. Am J Sports Med 22:659–666

    Article  CAS  Google Scholar 

  14. Koga H, Muneta T, Yagishita K, Watanabe T, Mochizuki T et al (2015) Mid- to long-term results of single-bundle versus double-bundle anterior cruciate ligament reconstruction: Randomized controlled trial. Arthroscopy 31:69–76

    Article  Google Scholar 

  15. Laboute E, James-Belin E, Puig PL, Trouve P, Verhaeghe E (2018) Graft failure is more frequent after hamstring than patellar tendon autograft. Knee Surg Sport Traumatol Arthrosc 26:3537–3546

    Article  CAS  Google Scholar 

  16. Lertwanich P, Kato Y, Martins CAQ, Maeyama A, Ingham SJM et al (2011) A biomechanical comparison of 2 femoral fixation techniques for anterior cruciate ligament reconstruction in skeletally immature patients: over-the-top fixation versus transphyseal technique. Arthroscopy 27:672–680

    Article  Google Scholar 

  17. Lo IKY, Kirkley A, Fowler PJ, Miniaci A (1997) The outcome of operatively treated anterior cruciate ligament disruptions in the skeletally immature child. Arthroscopy 13:627–634

    Article  CAS  Google Scholar 

  18. Marcacci M, Zaffagnini S, Iacono F, Neri MP, Loreti I et al (1998) Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons. Knee Surg Sport Traumatol Arthrosc 6:68–75

    Article  CAS  Google Scholar 

  19. Nakamae A, Ochi M, Deie M, Adachi N, Shibuya H et al (2014) Clinical outcomes of second-look arthroscopic evaluation after anterior cruciate ligament augmentation: comparison with single- and double-bundle reconstruction. Bone Jt J 96B:1325–1332

    Article  Google Scholar 

  20. Offerhaus C, Albers M, Nagai K, Arner JW, Höher J et al (2018) Individualized anterior cruciate ligament graft matching. In vivo comparison of cross-sectional areas of hamstring, patellar, and quadriceps tendon grafts and ACL insertion area. Am J Sports Med 46:2646–2652

    Article  Google Scholar 

  21. Radford WJ, Amis AA (1990) Biomechanics of a double prosthetic ligament in the anterior cruciate deficient knee. J Bone Jt Surg Br 72:1038–1043

    Article  CAS  Google Scholar 

  22. Roberti di Sarsina T, Macchiarola L, Signorelli C, Grassi A, Raggi F et al (2019) 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 Sport Traumatol Arthrosc 27:498–506

    Article  Google Scholar 

  23. Ruffilli A, Buda R, Pagliazzi G, Baldassarri M, Cavallo M et al (2015) Over-the-top anterior cruciate ligament reconstruction using single- or double-strand hamstrings autograft. Orthopedics 2015:e635–e643

    Article  Google Scholar 

  24. Samuelsen BT, Webster KE, Johnson NR, Hewett TE, Krych AJ (2017) Hamstring autograft versus patellar tendon autograft for ACL reconstruction: is there a difference in graft failure rate? A meta-analysis of 47,613 patients. Clin Orthop Relat Res 475:2459–2468

    Article  Google Scholar 

  25. Sarraj M, de Sa D, Shanmugaraj A, Musahl V, Lesniak BP (2019) Over-the-top ACL reconstruction yields comparable outcomes to traditional ACL reconstruction in primary and revision settings: a systematic review. Knee Surg Sport Traumatol Arthrosc 27:427–444

    Article  Google Scholar 

  26. Usman MA, Kamei G, Adachi N, Deie M, Nakamae A et al (2015) Revision single-bundle anterior cruciate ligament reconstruction with over-the-top route procedure. Orthop Traumatol Surg Res 101:71–75

    Article  CAS  Google Scholar 

  27. van Eck CF, Gravare-Silbernagel K, Samuelsson K, Musahl V, van Dijk CN et al (2013) Evidence to support the interpretation and use of the anatomic anterior cruciate ligament reconstruction checklist. J Bone Jt Surg 95:e153

    Article  Google Scholar 

  28. Webster KE, Feller JA, Leigh WB, Richmond AK (2014) Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med 42:641–647

    Article  Google Scholar 

  29. Wright RW, Dunn WR, Amendola A, Andrish JT, Bergfeld J et al (2007) Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction. Am J Sports Med 35:1131–1134

    Article  Google Scholar 

  30. Zaffagnini S, Signorelli C, Lopomo N, Bonanzinga T, Muccioli GMM et al (2012) 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 Sport Traumatol Arthrosc 20:153–159

    Article  CAS  Google Scholar 

  31. Zaffagnini S, Marcheggiani Muccioli GM, Grassi A, Roberti di Sarsina T, Raggi F et al (2017) 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 45:3233–3242

    Article  Google Scholar 

  32. Zanovello J, Rosso F, Bistolfi A, Rossi R, Castoldi F (2017) Combined intra- and extra-articular technique in revision anterior cruciate ligament reconstruction. Joints 5:156–163

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Kanto Nagai, Benjamin B. Rothrauff, Ryan T. Li & Freddie H. Fu

  2. Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan

    Kanto Nagai

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  1. Kanto Nagai
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  2. Benjamin B. Rothrauff
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Correspondence to Freddie H. Fu.

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The authors declare no conflicts of interest in association with the present study.

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This research does not have any funding sources.

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The institutional review board (IRB) for human subject research in University of Pittsburgh approved all aspects of this study (ID: STUDY19030196).

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No informed consent was needed in this study because this is a retrospective chart review of standard care procedures of de-identified patients.

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Nagai, K., Rothrauff, B.B., Li, R.T. 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 28, 538–543 (2020). https://doi.org/10.1007/s00167-019-05719-5

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  • DOI: https://doi.org/10.1007/s00167-019-05719-5

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