Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Orthopedic Surgery

Background: ACL injuries are common knee injuries. The current concept of ASB reconstruction is believed to restore AP stability, but ignores the rotational stability. A residual pivot shift seen in up to quarter of ACL reconstructions. Based on cadaveric studies and clinical trials; light has been thrown on the importance of the PL bundle and its role in rotational stability, hence the concept of ADB reconstruction. Extra-articular procedures are suggested to achieve better rotational control. The ALL; is a new anatomically discovered lateral knee structure, proposed to be responsible for rotational knee stability. Patients and methods: Between January 2015 and December 2016, a RCT was conducted on 40 patients suffering from chronic ACL injuries or acute injuries with high grade knee jerk or in high demand athletes. Twenty patients (group A) were treated with ASB ACL reconstruction and ALL extra-articular augmentation. The other 20 patients (group B) were managed with ADB ACL reconstructions. In group A; the ST was prepared into ACL graft, fixed with interference bio-screw on the femoral side and U-loop on the tibial side. The "G" was prepared into the ALL graft. It is fixed on the femoral side with interference bio-screw and distally tied over the U-loop. In group B; the ST was prepared as the AM bundle, while the "G" was prepared as the PL bundle. Two separate femoral and tibial tunnels were drilled. The grafts were fixed with Endo-buttons on the femoral side and interference bio-screws on the tibial side

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