过顶位联合前外侧关节外肌腱固定术重建前交叉韧带：成功十要诀
简介
基于Rizzoli骨科研究所30年、约6000例手术经验，本文总结了Over-the-top（OTT）联合外侧关节外肌腱固定术（LET）前交叉韧带（ACL）重建的10个实用技术要点，旨在预防和处理术中并发症。关键步骤包括：保留远端腘绳肌腱血供、解剖位胫骨骨道定位、精细制备OTT股骨通道、安全建立外侧窗口并保护后方结构、控制移植物通过避免成团或扭结、精确置入前…
英文摘要
PURPOSE: Over-the-top (OTT) plus Lateral Extra-articular Tenodesis (LET) anterior cruciate ligament (ACL) reconstruction has been performed continuously at the Rizzoli Orthopedic Institute since 1993, with approximately 6000 procedures completed and long-term follow-up reported up to 25 years. Despite its durability and reproducibility, detailed technical updates have been limited. The purpose of this review is to summarise 10 practical tips aimed at preventing and managing intra-operative complications during OTT ACL reconstruction. METHODS: This technical review is based on three decades of cumulative institutional experience with OTT plus LET ACL reconstruction across diverse patient populations, including skeletally immature patients, amateur athletes, elite professional soccer players and revision cases. Key technical steps are presented in a structured 'Ten Tips' format, emphasising strategies to preserve graft biology, ensure anatomic positioning and avoid intra-operative pitfalls. RESULTS: Critical elements include preservation of distal hamstring vascularity, anatomic tibial tunnel placement, meticulous preparation of the OTT femoral pathway, safe lateral window development with protection of posterior structures, controlled graft passage to avoid clumping or kinking, precise anterior-distal staple insertion to prevent posterior femoral cortical fracture and standardised completion of the LET. Attention to these principles minimises technical errors, protects the neurovascular bundle and PCL and promotes optimal graft orientation as demonstrated by magnetic resonance imaging-based inclination parameters. CONCLUSION: When performed with meticulous technique and adherence to reproducible surgical principles, OTT plus LET ACL reconstruction remains a versatile, economical and biologically favourable procedure capable of achieving anatomic graft positioning while avoiding femoral tunnel-related complications. These 10 technical recommendations provide a structured framework for reducing intra-operative complications and optimising outcomes. LEVEL OF EVIDENCE: Level V, expert opinion.