OTT ✅ Comparison Studies
https://pmc.ncbi.nlm.nih.gov/articles/PMC11780662/
- 👥 75 patients randomized (25 per group) to:
- BPTB
- SB Quadrupled HT (no LET)
- Over-the-Top
- 📊 Clinical outcomes:
- 📉 Failure rates (revision):
- BPTB: 16%
- HT: 10%
- OTT: 5%
- 🦴 Osteoarthritis:
- No increase in lateral OA with HT + LET
- BPTB showed significantly higher patellofemoral OA vs HT + LET (p = .029).
- 📏 Knee laxity:
Mean follow-up: 23 years
All three techniques showed comparable PROMs at 20+ years.
HT + LET had a slightly higher Tegner score vs BPTB (p = .023).
Trend toward fewer revisions with OTT + LET (not statistically significant).
BPTB had slightly less AP laxity than HT;
HT + LET was comparable and did not increase instability.
Bottom Line
At >20 years, Over-the-Top HT + LET performs at least as well as standard tunnel techniques, with a trend toward fewer failures and no evidence of lateral overconstraint or OA progression.
https://pubmed.ncbi.nlm.nih.gov/30078121/
- 👥 16 studies included (3 RCTs, 13 case series)
- Primary OTT: 453 patients (mean age 26.9 yrs)
- Revision OTT: 60 patients (mean age 31.4 yrs)
- Mean follow-up ≈ 5.8 years
- 📊 Clinical outcomes comparable to traditional techniques
- Mean Lysholm (primary): 89.9
- Mean subjective IKDC: ~82
- Mean Tegner: 6.5
- 🔄 Rotational stability strong
- Positive pivot shift only 7.8%
- ⚽ Return to sport (primary cases):
- 94% returned to sport
- 69% returned to pre-injury level
- ❌ Failure rates low
- Primary graft failure: 3.7%
- Revision failure: 8.4%
- 🧠 Conclusion of the review:
lower than many reported transtibial or AM portal series
OTT ACL reconstruction demonstrates clinically important outcomes comparable to traditional all-inside, transtibial, and anteromedial portal techniques, in both primary and revision settings.