ISAKOS: 2019 Congress in Cancun, Mexico

2019 ISAKOS Biennial Congress ePoster #838


Ten-Years Survival of the Anterior Cruciate Ligament Reconstruction with an ''Over-The-Top" plus Lateral-Plasty Technique: Analysis of 322 Consecutive Cases

Stefano Zaffagnini, MD, Prof., Bologna ITALY
Alberto Grassi, PhD, Bologna ITALY
Luca Macchiarola, MD, Foggia ITALY
Federico Stefanelli, MD, Bologna ITALY
Maurilio Marcacci, MD, Milano, Milano ITALY

Istituto Ortopedico Rizzoli - University of Bologna , Bologna, ITALY

FDA Status Cleared


The ACL reconstruction technique with hamstring tendons "over-the-top" and external plasty has demonstrated a low revision rate of 3%, comparable with conventional techniques



Numerous techniques has been described for anterior cruciate ligament (ACL) reconstruction, with an failure rate of
around 2-5%. The single-bundle over-the-top reconstruction with hamstring tendons combined with lateral plasty has
proved to be effective biomechanically sound and clinically effective also compared to standard techniques. However, the
long-term failure rate on large scale samples has not been determined yet. The objective of this study was therefore to
evaluate the rate of re-rupture of the graft in a large long-term sample.


322 consecutive patients treated from 2007 to 2008 of ACL reconstruction with hamstring tendons and the "over-the-top"
single-bundle technique plus lateral-plasty in a single center were surveyed with the validated questionnaire VAS, KOOS,
Lysholm and Tegner. Informations on postoperative complications and reoperations were also collected. Failure was
considered in the case of a new ACL reconstruction of the affected knee. Survival analysis was performed for failure and
for the occurrence of ACL revision or ipsilateral meniscectomy.


Overall, 83% of patients evaluated; the patients lost at follow-up showed demographic characteristics similar to the
patients surveyed. The mean age of the patients was 31 ± 11, with a male prevalence (77%) and an average follow-up of
10 ± 0.5 years. Overall 44% had a medial meniscal lesion and 21% had lateral meniscal lesion. A chondropaty >I° was
reported 9% and 3% for lateral and medial compartment, respectively. In total 3.0% of the patients underwent revision of
the LCA during the considered follow-up, with a 2-year survival rate of 99.2%, 4-year of 98.4%, at 6-year of 97.6%, 8 and
10-year of 97.2%. Also, 3.7% underwent meniscectomy, 4.9% underwent hardware removal and 0.4% developed a deep
infection. The overall survival free from surgery at 10 years was 86.5%, while the survival free from ACL revision or
meniscectomy was 92.8%. A concurrent medial meniscus lesion at time of ACL reconstruction (OR=2.6) and a preoeprative
Tegner >5 (OR=7.0) were predictors of ACL revision or meniscectomy.
The mean VAS at the final follow-up was 0.2 ± 0.5, the average Lysholm was 94 ± 12 and the mean KOOS subscales
were 91±18 (Qol), 92±11 (Symptoms), 98±4 (ADL), 90±17 (Sport) and 95±9 (Pain). The Tegner significantly improved
from 1 (1-3) to 5 (4-7) postoperatively and maintained at 4 (1-5) at the final follow-up. Condropaty and female sex were
found to be significant predictors of worst clinical outcomes (p<0.05) especially for KOOS Qol, sport and Pain subscales.

Discussion And Conclusion

The ACL reconstruction technique with hamstring tendons "over-the-top" and external
plasty has demonstrated a low revision rate of 3%, comparable with conventional techniques, and good long-term clinical
and functional results. High Tegner activity, a concurrent medial meniscus injury, female sex and condropaty have been
found to predict failure, medial mniescecomty or clinical outcomes.