Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis: The “Over-the-Top” Technique
Background: The anterior cruciate ligament (ACL) is a primary restraint to anteroposterior as well as rotatory knee laxity. In case of concomitant lesion of menisci or other ligamentous structures, further dynamic instability is encountered. A lateral extra-articular tenodesis (LET) augmentation has...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2023-09-01
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| Series: | Video Journal of Sports Medicine |
| Online Access: | https://doi.org/10.1177/26350254231177378 |
| _version_ | 1797661608904753152 |
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| author | Stefano Zaffagnini MD Alberto Grassi MD Gian Andrea Lucidi MD Giacomo Dal Fabbro MD Luca Ambrosini MD |
| author_facet | Stefano Zaffagnini MD Alberto Grassi MD Gian Andrea Lucidi MD Giacomo Dal Fabbro MD Luca Ambrosini MD |
| author_sort | Stefano Zaffagnini MD |
| collection | DOAJ |
| description | Background: The anterior cruciate ligament (ACL) is a primary restraint to anteroposterior as well as rotatory knee laxity. In case of concomitant lesion of menisci or other ligamentous structures, further dynamic instability is encountered. A lateral extra-articular tenodesis (LET) augmentation has been proposed by the Authors to treat or prevent residual laxity. Indications: ACL reconstruction is recommended in young athletes involved in pivoting sports, non-contact pivoting injuries, high-grade pivot shift, deep notch sign and double bone bruise, meniscal loss, and revision of previous bone-patellar tendon-bone autograft. Technique Description: A 2 to 3 cm oblique incision is made over the pes anserinus. Gracilis and semitendinosus tendons are harvested with their attachment preserved and sutured together. Tibial tunnel is reamed after positioning of a guide pin. A wire-loop passer is directed from the tibial tunnel to the anteromedial portal. A 2 to 3 cm longitudinal incision is made superior-laterally, the ileotibial band is divided and retracted anteriorly. A suture-loop is retrieved from the lateral incision through the anteromedial portal with a curved Kelly clamp. The suture is placed into the wire-loop and retrieved with it from the tibial tunnel. The graft is retrieved from the lateral incision, tensioned with the knee at 70° to 90° of flexion and foot in neutral rotation and secured with 2 staples to the femur. A 1-cm skin incision is performed just below the Gerdy tubercle. The graft is retrieved from this incision below the fascia with a small Kelly clamp, tensioned and secured with a staple. The iliotibial tract defect is closed. Results: At long-term follow-up, a revision rate of 3% has been reported, while patient-reported outcome measures (PROMs) were excellent. At very-long-term follow-up, most patients were still involved in sports with a very low rate of positive Lachman and pivot shift tests. No overconstraint and lateral osteoarthritis were encountered. Medial osteoarthritis was related only to medial meniscectomy. Discussion/Conclusion: The ACL reconstruction plus LET over-the-top technique is a safe and reliable surgery with a low rate of reoperations and peri-operative complications at very-long-term follow-up. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. |
| first_indexed | 2024-03-11T18:47:08Z |
| format | Article |
| id | doaj.art-c6a79fda591d4611b497ee9c9f95bc50 |
| institution | Directory Open Access Journal |
| issn | 2635-0254 |
| language | English |
| last_indexed | 2024-03-11T18:47:08Z |
| publishDate | 2023-09-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Video Journal of Sports Medicine |
| spelling | doaj.art-c6a79fda591d4611b497ee9c9f95bc502023-10-11T17:33:20ZengSAGE PublishingVideo Journal of Sports Medicine2635-02542023-09-01310.1177/26350254231177378Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis: The “Over-the-Top” TechniqueStefano Zaffagnini MD0Alberto Grassi MD1Gian Andrea Lucidi MD2Giacomo Dal Fabbro MD3Luca Ambrosini MD4II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, ItaliaII Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, ItaliaII Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, ItaliaII Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, ItaliaII Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, ItaliaBackground: The anterior cruciate ligament (ACL) is a primary restraint to anteroposterior as well as rotatory knee laxity. In case of concomitant lesion of menisci or other ligamentous structures, further dynamic instability is encountered. A lateral extra-articular tenodesis (LET) augmentation has been proposed by the Authors to treat or prevent residual laxity. Indications: ACL reconstruction is recommended in young athletes involved in pivoting sports, non-contact pivoting injuries, high-grade pivot shift, deep notch sign and double bone bruise, meniscal loss, and revision of previous bone-patellar tendon-bone autograft. Technique Description: A 2 to 3 cm oblique incision is made over the pes anserinus. Gracilis and semitendinosus tendons are harvested with their attachment preserved and sutured together. Tibial tunnel is reamed after positioning of a guide pin. A wire-loop passer is directed from the tibial tunnel to the anteromedial portal. A 2 to 3 cm longitudinal incision is made superior-laterally, the ileotibial band is divided and retracted anteriorly. A suture-loop is retrieved from the lateral incision through the anteromedial portal with a curved Kelly clamp. The suture is placed into the wire-loop and retrieved with it from the tibial tunnel. The graft is retrieved from the lateral incision, tensioned with the knee at 70° to 90° of flexion and foot in neutral rotation and secured with 2 staples to the femur. A 1-cm skin incision is performed just below the Gerdy tubercle. The graft is retrieved from this incision below the fascia with a small Kelly clamp, tensioned and secured with a staple. The iliotibial tract defect is closed. Results: At long-term follow-up, a revision rate of 3% has been reported, while patient-reported outcome measures (PROMs) were excellent. At very-long-term follow-up, most patients were still involved in sports with a very low rate of positive Lachman and pivot shift tests. No overconstraint and lateral osteoarthritis were encountered. Medial osteoarthritis was related only to medial meniscectomy. Discussion/Conclusion: The ACL reconstruction plus LET over-the-top technique is a safe and reliable surgery with a low rate of reoperations and peri-operative complications at very-long-term follow-up. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.https://doi.org/10.1177/26350254231177378 |
| spellingShingle | Stefano Zaffagnini MD Alberto Grassi MD Gian Andrea Lucidi MD Giacomo Dal Fabbro MD Luca Ambrosini MD Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis: The “Over-the-Top” Technique Video Journal of Sports Medicine |
| title | Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis: The “Over-the-Top” Technique |
| title_full | Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis: The “Over-the-Top” Technique |
| title_fullStr | Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis: The “Over-the-Top” Technique |
| title_full_unstemmed | Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis: The “Over-the-Top” Technique |
| title_short | Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Tenodesis: The “Over-the-Top” Technique |
| title_sort | combined anterior cruciate ligament reconstruction and lateral extra articular tenodesis the over the top technique |
| url | https://doi.org/10.1177/26350254231177378 |
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