rior cruciate ligament reconstruction is one of the most commonly performed surgeries dwide, but there remains a lack of evidence about one technique being preferable to another. ssor Marcacci and his equipe developed in 1992 a surgical technique called "over the top" lateral plasty, using autologous ipsilateral gracilis and semitendinosus muscles tendons. • Only one tibial tunnel is required, reducing the risk of graft malplacement, making this technique suitable also for revision cases. • Cheap and reliable fixation devices (metal staples), reducing surgical time and allowing early rehabilitation. • The additional lateral plasty makes this technique reliable in addressing multidirectional laxities, not only anteroposterior but also rotational ones, making this technique comparable to a double-bundle one. In this chapter, the "over the top" plus extraarticular plasty ACL reconstruction will be described, relating it to the current concepts of reconstruction and laxity assessment. The highly satisfactory results obtained over the time with the above-reported technique show that a combination of intra- and extra-articular procedures for ACL reconstruction is a valid surgical option in the ACLdeficient knee.
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