Du Haocheng, Li Lin, Qin Ziwen, Guo Jiang, Zhang Xintao
Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, China.
Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China.
Orthop Surg. 2025 Feb;17(2):333-347. doi: 10.1111/os.14328. Epub 2024 Dec 29.
Anterior cruciate ligament (ACL) injuries are the most common knee joint injuries related to sports activities in clinical practice. For treating ACL injuries, anatomical reconstruction surgery is often the preferred method. The over-the-top (OTT) technique is a surgical approach that eliminates the need for creating a femoral tunnel. According to the existing literature, the OTT technique offers distinct advantages, particularly for skeletally immature individuals and in revision cases. Currently, femoral tunnel failure is the most common cause of ACL reconstruction failure, which can lead to less than optimal postoperative performance of the ACL and a higher likelihood of needing a revision. Additionally, mistakes in the placement of the femoral tunnel and the subsequent risk of tunnel enlargement can increase the complexity of revision procedures, ultimately reducing the long-term clinical effectiveness for patients. In contrast, the OTT technique has shown excellent biomechanical performance, avoids the need for bone tunnels, is economically practical, and has been proven to provide satisfactory therapeutic outcomes both in the short and long term, especially for skeletally immature individuals and in revision cases. The OTT technique is deemed a safe and effective surgical method for treating ACL injuries. In summary, the OTT technique has unique benefits for skeletally immature individuals and in revision cases, making it a viable option worth considering. Level of evidence V.
前交叉韧带（ACL）损伤是临床实践中与体育活动相关的最常见膝关节损伤。对于治疗ACL损伤，解剖重建手术通常是首选方法。过顶（OTT）技术是一种无需创建股骨隧道的手术方法。根据现有文献，OTT技术具有明显优势，特别是对于骨骼未成熟个体和翻修病例。目前，股骨隧道失败是ACL重建失败的最常见原因，这可能导致ACL术后性能不理想，以及需要翻修的可能性更高。此外，股骨隧道放置错误以及随后隧道扩大的风险会增加翻修手术的复杂性，最终降低患者的长期临床疗效。相比之下，OTT技术已显示出优异的生物力学性能，无需骨隧道，经济实用，并且已被证明在短期和长期内均能提供令人满意的治疗效果，特别是对于骨骼未成熟个体和翻修病例。OTT技术被认为是治疗ACL损伤的一种安全有效的手术方法。总之，OTT技术对于骨骼未成熟个体和翻修病例具有独特优势，使其成为一个值得考虑的可行选择。证据级别V。
