ObjectiveInitiated by the Knee Group of the Chinese Society of Sports Medicine and the Arthroscopy Group of the Chinese Association of Orthopaedic Surgeons, domestic experts in the field were organized to develop a Chinese expert consensus on anterior cruciate ligament (ACL) reconstruction using the over-the-top (OTT) technique, based on the latest clinical practices and research advancements. This consensus aims to standardize and promote the application of this technique in ACL reconstruction. Methods The consensus was reached using the modified Delphi method and was completed through two rounds of online questionnaire surveys and one round of face-to-face expert meeting discussions. The consensus was jointly formulated by 43 sports medicine experts from grade Ⅲ class A hospitals across 20 provinces, autonomous regions and municipalities of China. Among them, 7 experts served as guiding experts. The consensus drafting team drafted the first draft of the consensus based on evidence-based evidence and transformed it into questionnaire items. The second draft was revised according to the feedback from the first round of questionnaires and discussed, revised and voted on item by item in face-to-face meetings. Items with an approval rate of ≥85% were recognized as having reached a consensus. The consensus terms were categorized as “strong” (approval rate: 95.0%-100%), “moderate” (approval rate: 90.0%-94.9%), and “basic” (approval rate: 85.0%-89.9%). ResultsAll 43 experts completed the entire process and participated in the face-to-face meeting. Ultimately, 9 consensus statements were agreed upon, including 8 highly-consensus items and 1 general consensus item, covering surgical indications, technical key points, and postoperative rehabilitation. ConclusionThe ACL OTT reconstruction technique does not require the establishment of a femoral tunnel and demonstrates favorable outcomes in adolescent ACL reconstruction and adult ACL revision, making it a viable surgical option for such patients. However, whether OTT reconstruction should be routinely recommended for primary ACL reconstruction in adults requires further clinical research to confirm its standardized application and ensure clinical efficacy.