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

The anterior cruciate ligament is an important, internal, stabilizer of the knee joint, restraining hyperextension. It is injured when its biomechanical limits are exceeded (over stretched), often with a hyperextension mechanism. The pivot-shift test, anterior drawer test and Lachman test are used during the clinical examination of suspected ACL injury. The Lachman test is recognized by most authorities as the most reliable and sensitive test, and usually superior to the anterior drawer test. Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure aimed to restore normal knee kinematics. Although a wide variety of single- or double-bundle anatomic ACL reconstruction using hamstrings tendons are described in the literature, all of these procedures require the detachment of the tendons from their tibial insertion.2,3 It has been demonstrated that preservation of the hamstrings tendons insertion allows preservation of the neurovascular supply of the tendons, resulting in residual proprioceptivity and better ligamentization of the graft.3 Until now, the only techniques that spare the hamstrings tendons insertion encompass a femoral over-the-top passage. Although these techniques are able to guarantee a successful clinical outcome, even at long-term follow-up, the over-the-top femoral route is not ana-tomical

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