Early clinical outcomes of over-the-top anterior cruciate ligament reconstruction combined with lateral extra-articular tenodesis

doi:10.5312/wjo.v17.i6.119923

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 17, Issue 6

This Article

(2)

(0)

(2)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Orthopedics

ISSN

2218-5836

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. Jun 18, 2026; 17(6): 119923
Published online Jun 18, 2026. doi: 10.5312/wjo.v17.i6.119923

Early clinical outcomes of over-the-top anterior cruciate ligament reconstruction combined with lateral extra-articular tenodesis

Wan-Qing Qi, Ya-Qing Zhao, Yun-Qing Su, Qian-Ru Yao, Xian-Xiang Xiang

Wan-Qing Qi, Yun-Qing Su, Qian-Ru Yao, Xian-Xiang Xiang, Department of Sports Medicine, Dalian University Affiliated Xinhua Hospital, Dalian 116021, Liaoning Province, China

Ya-Qing Zhao, Department of Orthopedics, Dalian University Affiliated Zhongshan Hospital, Dalian 116001, Liaoning Province, China

Co-first authors: Wan-Qing Qi and Ya-Qing Zhao.

Author contributions: Qi WQ and Zhao YQ contributed equally to this work; Qi WQ conceptualized, collated data, conducted form analysis, and drafted the original manuscript for this research; Zhao YQ conducted the investigation, methods, visualization, writing - review and editing for this research; Su YQ carried out data collection, literature search and manuscript revision for this research; Yao QR conducted data analysis, chart creation and final review and revision for this research.

Institutional review board statement: This research plan has been reviewed and approved by the Ethics Committee of Xinhua Hospital Affiliated to Dalian University (Ethical approval No: 2023-175-01).

Informed consent statement: All the enrolled patients were fully informed about the study content, risks and benefits, and voluntarily signed the written informed consent form.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

Data sharing statement: The datasets generated and analyzed during the current study are not publicly available due to the protection of patient privacy and confidentiality, but are available from the corresponding author on reasonable request.

Corresponding author: Xian-Xiang Xiang, PhD, Associate Professor, Deputy Director, Postdoc, Department of Sports Medicine, Dalian University Affiliated Xinhua Hospital, No. 156 Wansui Road, Dalian 116021, Liaoning Province, China. xiangxianxiang@dlu.edu.cn

Received: February 26, 2026
Revised: April 7, 2026
Accepted: April 22, 2026
Published online: June 18, 2026
Processing time: 122 Days and 16.7 Hours

Abstract

BACKGROUND

The anterior cruciate ligament (ACL) ensures knee stability in anterior-posterior and rotational directions. Arthroscopic ACL reconstruction (ACLR) is the gold standard for ACL injuries. Although modified Lemaire lateral extra-articular tenodesis (LET) is increasingly used, high-quality evidence on ACLR combined with LET remains limited. Given that combining over-the-top (OTT) with ACLR and modified Lemaire LET shows limited efficacy in high pivot-shift patients, this study retrospectively evaluated short-term outcomes. We hypothesize this approach significantly improves rotational stability, supports return to sports, and achieves good short-term clinical results.

AIM

To confirm short-term efficacy of over-the-top ACL reconstruction with lateral extra-articular tenodesis for primary ACL tear and positive pivot shift.

METHODS

Fifty-six patients (34 males; 22 females) aged 15-45 years (mean age, 28 ± 10.5 years) with ACL injuries (22 left knees and 34 right knees) characterized by a high pivot shift who had undergone OTT ACL reconstruction in conjunction with modified Lemaire LET between March 2020 and October 2022 were included. The time from injury to surgery was 10-32 days. Outcomes (Lysholm, International Knee Documentation Committee, KT-2000) were recorded preoperatively and during a 24-month follow-up period.

RESULTS

All patients were followed up for a minimum of 24 months and successfully returned to sports activities. Both pivot-shift and Lachman tests were negative postoperatively. At the 24-month follow-up, magnetic resonance imaging revealed no ACL retears. The Lysholm score increased from 60.5 ± 4.5 to 92.4 ± 2.6 (P < 0.001), International Knee Documentation Committee score increased from 52.3 ± 2.6 to 92.8 ± 3.0 (P < 0.001), and KT-2000 side-to-side difference decreased from 5.4 ± 1.0 mm to 1.4 ± 0.3 mm (P < 0.001).

CONCLUSION

OTT-ACLR combined with the modified Lemaire LET is associated with improved knee rotational stability in patients with high pivot-shift ACL injuries, facilitating their return to sports with favorable short-term clinical outcomes.

Keywords: Anterior cruciate ligament reconstruction; Over-the-top; Anterolateral complex; Modified Lemaire procedure; Arthroscopic surgery

Core Tip: This study summarizes the clinical characteristics and treatment progress of patients with anterior cruciate ligament (ACL) tear accompanied by high grade pivot-shift test. We found that the over-the-top ACL reconstruction combined with lateral extra-articular tenodesis can effectively improve the clinical outcome and reduce complications, providing a reliable reference basis for the clinical diagnosis and treatment of ACL tear accompanied by high grade pivot-shift test.