CC-BY-NC-ND 4.0 · Joints 2017; 05(03): 156-163
DOI: 10.1055/s-0037-1605590
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Combined Intra- and Extra-Articular Technique in Revision Anterior Cruciate Ligament Reconstruction

Jessica Zanovello1, Federica Rosso2, Alessandro Bistolfi3, Roberto Rossi2, Filippo Castoldi4
  • 1Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, University of Turin, Hospital Città della Salute e della Scienza, Turin, Italy
  • 2Department of Orthopaedics and Traumatology, University of Turin, AO Mauriziano “Umberto I” Hospital, Turin, Italy
  • 3Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, Hospital Città della Salute e della Scienza, Turin, Italy
  • 4Department of Orthopaedic Surgery, University of Turin, San Luigi Hospital of Orbassano, Turin, Italy
Further Information

Publication History

Publication Date:
11 August 2017 (eFirst)


Purpose The aim of the study was to evaluate the “over the top” (OTT) nonanatomical technique for revision of anterior cruciate ligament (ACL) reconstruction.

Methods Twenty-four patients with a mean age of 31.9 ± 11.2 years underwent revision of ACL reconstruction using OTT technique. International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner score, Subjective Patient Outcome for Return to Sport (SPORTS) score, Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) scale, and KT-1000 evaluation were recorded at a mean follow-up of 30.7 ± 18.9 months.

Results Postoperatively, the IKDC objective total score significantly improved (p = 0.0046). The KOOS, Lysholm, and Tegner scores also improved, but the results were not statistically significant (62.4 vs. 72.6, 6.5 vs. 75.8, and 4.1 vs. 6.0, respectively). The subjective IKDC evaluation score improved from an average of 51.1 points to 63.7 points at the last follow-up (p = 0.0027). The RTP prevalence was 81.8%, with 44.4% of the patients returning to the same preinjury level. According to the SPORTS score, 16.6% of patients played sport without limitations in activity and performance. The average ACL-RSI score was 52.1 ± 27.0. No major complications were reported. A total of 21.5% of patients underwent surgical removal of staples. The failure prevalence was 14.3% and the cumulative survivorship, calculated using the Kaplan–Meier method, was equal to 70% at 60 months of follow-up.

Conclusion The OTT technique in the revision ACL reconstruction provided improvement in objective and subjective scores, good RTP prevalence, and acceptable rate of complication and failure. One of the advantages was the possibility to avoid the femoral tunnel.

Level of Evidence Level IV, therapeutic case series.