OTT 🎙️ Special Editorials/ Commentaries
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https://www.arthroscopyjournal.org/article/S0749-8063(21)00366-2/fulltext
- 🔄 Core message: Isolated ACL reconstruction is not sufficient to control rotational instability in chronic complex ACL injuries
- ➕ Lateral extra-articular tenodesis (LET) is necessary to restore rotational control, regardless of single- or double-bundle technique
- ⚖️ Caution against over-complexity: Double-bundle + LET may improve certain biomechanical parameters, but added technical complexity increases risk without proven clinical superiority
- 🧠 Philosophy: Neither single- nor double-bundle reconstruction is truly “anatomic.” The take-home principle:
“Keep it simple. Keep it safe.”
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https://pubmed.ncbi.nlm.nih.gov/38296446/
- 👥 Paper type: Editorial commentary reviewing evidence on non-traumatic ACL graft failure and femoral tunnel malposition (Arthroscopy 2024, Lucidi et al.)
- 🎯 Main message: The number one cause of ACL reconstruction failure is a misplaced femoral tunnel, typically too anterior or too vertical (Arthroscopy 2024, Lucidi et al.)
- 📊 Technical error prevalence: In revision cohorts, technical errors account for ~60% of failures, and femoral tunnel malposition is implicated in up to 80% (Arthroscopy 2024, Lucidi et al.)
- ⚠️ Consequences of malposition:
- Increased anterior translation
- Residual pivot shift
- Higher postoperative meniscal tears
- Increased revision rates (Arthroscopy 2024, Lucidi et al.)
- 🔁 Proposed solution:
- 🛠 Revision advantage:
The Over-The-Top technique + lateral extra-articular tenodesis (LET) avoids femoral tunnel malposition and improves rotatory control, particularly in patients with narrow notch or high tibial slope (Arthroscopy 2024, Lucidi et al.)
If failure occurs, there is no femoral tunnel widening, osteolysis, or hardware conflict, simplifying revision surgery (Arthroscopy 2024, Lucidi et al.)