Over-the-Top vs. Anteromedial ACLR With Lateral Extraarticular Tenodesis

Condition(s) studied

Investigational drug(s) / intervention(s)

OTT ACLR: Patients in this group will undergo a reconstruction with the OTT technique which includes an intra-articular component and an extra-articular one, functioning as a LET.

ACLR LET: Patients in this group will undergo a reconstruction with the conventional ACL technique accompanied by a routine LET, obtained from the iliotibial band.

Study summary

This study aims to compare the over-the-top (OTT) anterior cruciate ligament (ACL) reconstruction (ACL-R) technique with the anteromedial ACL-R + lateral extraarticular tenodesis (LET). It aims to provide valuable insights into two different surgical approaches aimed at enhancing knee stability. The over-the-top ACL-R technique, which involves routing the graft over the posterior aspect of the lateral femoral condyle, is known for its simplicity and ability to preserve the anatomical footprint of the ACL. Although a non-anatomical reconstruction, the OTT technique has shown comparable clinical results and good return to sports (RTS) ratios when compared to the conventional ACLR alone. It is also favored in revision surgeries or when there is difficulty accessing the femoral tunnel through conventional approaches. However, concerns regarding its ability to fully restore rotational stability persist, especially in high-demand athletes.

In contrast, the anteromedial portal technique for ACL-R, combined with LET, has gained popularity due to its effectiveness in controlling both anterior tibial translation and rotational instability. LET augments the intra-articular reconstruction by providing additional restraint against pivot shifts, which can be critical in patients with high-risk profiles for re-injury, such as those participating in pivoting sports. Comparing these two approaches in terms of clinical outcomes, graft integrity, rotational control, and return-to-sport rates with a prospectively randomized controlled trial will help clarify their roles in contemporary ACL surgery and could guide surgeons in choosing the most appropriate method based on patient-specific factors.

Eligibility

Primary outcome measure(s)

• Re-rupture — Postoperative 1.st year
  Re-rupture prevalence detected on MRI (yes/no)
• Tibial tunnel widening — Postoperative 1.st year
  Tibial tunnel diameter measured at the widest point on axial CT scans (number, mm)
• Tegner Activity Scale — Postoperative 1.st year
  minimum value:0, maximum value 10, higher values mean better outcome
• Knee Score ve Knee Injury & Osteoarthritis Outcome (KOOS) — Postoperative 1.st year
  minimum value:0, maximum value 100, higher values mean better outcome

Trial sites (1)

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