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.