Strain characteristics of anterior cruciate ligament grafts inserted in the over-the-top technique were studied in an in-vitro model. A cruciate ligament attached at the center of the anatomical insertion sites provides a constant preload and accomplishes the principle of isometry during the whole range of motion. In contrast, the over-the-top reconstructed ligament shows an increasing laxity proportional to the degree of joint flexion due to an approach of the attachment areas. These observations indicate that a sufficient ligament function is not provided so that the over-the-top reconstruction cannot be recommended as method of choice.
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