Clinical Application of Over-The-Top Reconstruction Technique in Patients with Unclosed Epiphysis and Anterior Cruciate Ligament Injury

Li Shilin; Lu Mingfeng; Zhou Jie; Zhao Lilian; He Lilei; Li Yanye

Abstract：Objective To analyze the clinical efficacy of over the top(OTT)reconstruction technique in treating anterior cruciate ligament(ACL)injuries in patients with open epiphyses.Methods 59 underage patients who underwent OTT ACL reconstruction at Foshan Hospital of Traditional Chinese Medicine from December 2018 to December 2023 and were followed up for more than one year were selected.There were 40 males with an average age of(14.21±1.55)years and 19 females with an average age of(13.08±0.61)years.The operation time,postoperative bleeding volume,hospital stay,patient and family satisfaction,return-to-sport rate,return-to-sport time,and MRI imaging were recorded.The Lysholm score,international knee documentation committee(IKDC)score,Tegner score,and KT-1000 difference were compared before and 3 months,6 months,12 months,and at the last follow-up after surgery.The anterior drawer test,Lachman test,and pivot shift test were compared before and 12 months after surgery.Complications were recorded.Results The average follow-up time was 15～25(20.61±2.54)months.The operation time was(96.56±25.31)min;the postoperative drainage volume was(21.65±5.82)mL;the hospital stay was(5.36±1.21)days.Postoperatively,44 patients were satisfied,11 were generally satisfied,and 4 were dissatisfied.Fifty-two patients returned to sports,with an average return-to-sport time of(12.92±0.90)months.One-year postoperative MRI showed complete healing in 52 cases and partial healing in 7 cases.At the last follow-up,the Lysholm score,IKDC score,and Tegner score were higher than those before surgery,and the KT-1000 difference was lower than that before surgery(P＜0.05);the anterior drawer test,Lachman test,and pivot shift test were all improved compared with those before surgery(P＜0.05).Two patients had graft re-rupture after surgery,and no complications such as abnormal development of both lower extremities,infection.or hemarthrosis were observed.Conclusion The OTT technique can achieve good knee stability and function in patients with open epiphyses and ACL rupture,with high patient satisfaction and return-to-sport rate.