Marcacci-Zaffagnini Over-The-Top (OTT) ACL Reconstruction Technique
with Lateral Extra-Articular Tenodesis
A Tunnel-Free Philosophy Backed by 25 Years of Clinical Evidence. Developed in 1993 at the Rizzoli Orthopaedic Institute, Bologna, Italy.
Biological, Live Graft
Healing without the dead zone.
Biomechanically Stable
Rotational control isn't optional—it's built in with lateral extra-articular support.
No Femoral Tunnel
Eliminating the leading technical cause of ACL failure.
Anatomical Graft Orientation
MRI-proven graft orientation within native ACL inclination envelopes.
The Rizzoli Over-the-Top ACL Reconstruction: When the leading technical cause of ACL failure is femur tunnel malposition, the most reliable solution may be simple: Don’t drill one. The OTT technique offers reproducible stability with 20+ year follow-up.
Outcomes
Surgical Technique
Technique Guides for the OTT ACL Reconstruction
One philosophy. Multiple applications. From primary to revision, extra-physeal to combined procedures — a complete surgical framework.
Our Preferred Implant: Citieffe Bone Staples
Low-profile titanium fixation. Secure. Reproducible. Time-tested. Made in Bologna, Italy.
Economical
Cost efficiency without compromise in outcomes.
Fast
Efficient construct. Reduced operative variability.
Safe
No femoral tunnel. No blowout. No tunnel collision.
The Creators
Developed at Rizzoli. Refined over three decades.
Prof. Maurilio Marcacci
Professor Maurilio MARCACCI is a specialist in orthopedics and traumatology. He is the author of over 400 publications, 48 book chapters, and 6 monographs. He is an inventor and holds 9 medical patents. His research has led him to coordinate numerous scientific projects funded by national and international institutions.
Prof. Stefano Zaffagnini
Professor Stefano ZAFFAGNINI is a surgeon specializing in Orthopedics and Traumatology, graduating with honors from the University of Bologna. Since 2017, he has held the position of Director of the Orthopedic and Traumatology Clinic II at the Rizzoli Orthopedic Institute in Bologna.
Prof Zaffagnini ⚽️ Case Series
Trusted at the Highest Level (Public Sources)
*A = Serie A Italian Soccer League
Over-the-Top Surgeons
Contact for fellowship opportunities at Rizzoli: geraldina.testa@ior.it
25-Year ExperienceSpecial CommentariesOTT Technique GuidesGeneral Population Follow-UpSpecial Populations Follow-UpOutcomes ComparedVascularity EvidenceUnderstanding Tunnel MalpositionBiomechanical EvidenceGraft Orientation EvidenceAlessandro CircatiLewis FergusonMattia De Sciglio Rizzoli Orthopaedic Institute