الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The anterior cruciate ligament (ACL) injury is the most common ligament injury in the knee and reported to represent about 1/3 of sports injuries to the knee joint. ACL has also an important function in carrying Loads throughout the entire knee motion and so it plays an important role in knee stability and proprioception. Reconstruction of the torn ACL is a common surgical procedure for orthopedic surgeons. The goal of any ACL reconstruction is to restore normal anterior knee stability to approximate normal knee kinematics. The ACL is composed of two bundles. The anteromedial bundle (AMB) becomes tense in flexion controlling mainly the AP translation. During extension, the effect of the posterolateral bundle (PLB) is more evident mainly on rotation. ACL reconstruction with autogenously gracilis and semitendinosus (G/ST) tendons graft has become a common surgical procedure with many advantages including low donor site morbidity and tendons can be harvested through a smaller incision than that used for harvesting bone-patellar tendon-bone (B-PT-B), which may help to minimize postoperative pain. The autograft arthroscopic single-bundle (SB) is the ―gold standard‖ technique for anterior cruciate ligament (ACL) reconstruction. The proper arthroscopic visualizing of femoral foot print is essential for anatomical ACL reconstruction. The femoral tunnel placement can be visualized by transpatellar portal viewing and use of the Accessory anteromedial portal (AAMP) for drilling the femoral tunnel was suggested as a method to place the graft in a more anatomical position and improve rotational stability. The aim of this study was to evaluate the result of arthroscopic anterior cruciate ligament reconstruction using transpatellar portal viewing. This study included thirty one patients in whom the torn anterior cruciate ligament will be reconstructed arthroscopically using transpatellar portal viewing and AAMP at Tanta University Hospital with a period of six months follow up. The patients’ age ranged from 21 years – 35 years with mean age 28.71 ± 3.69 years. There were two patients with uncontrolled type 1 diabetes mellitus, three patients were hypertensive otherwise the rest of patients free from medical conditions. The contact sport was the most common mechanism of injury (25 patients 80.6%), followed by work injuries in 5 patients (16.1%) and one patient (3.2%) had the injury after rood traffic accident (RTA). All patients were examined first with positive both anterior drawer test and Lachman test. The MRI was done to all patients with evident torn ACL. Intra-operatively, all Patients were laid supine with the affected knee flexed at the end of table, allowing knee flexion up to 120. The surgery began by harvesting the semitendinosus and gracilis tendons and preparing them. After creating the transpatellar (central) portal, the femoral tunnel was created through the anteromedial approach. Using the tibial C guide, the tibial tunnel was also created. The graft was introduced and the fixation was done using the femoral endbutton in the femur and interference screw in the tibia. After ACL reconstruction, patients were encouraged to use cold therapy for 48 hours and to bear weight as tolerated with the use of crutches. Accelerated rehabilitation program was followed and applied with an emphasis on full extension and quadriceps strengthening exercises. The patients’ final Lysholm score at 6 months, ranged from 70 % to 100 % with Mean equals 90.65 ± 10.67 the patients final scores are classified into 2 groups. The satisfactory group includes 29 patients (93.5%) with 26 patients (83.8%) were classified as excellent results and three patients were classified as good results (9.7%). The unsatisfactory group included two patients (6.5%) with a poor result. At the end of the follow up period, all patients’ knees became stable and had never gave way, there was a statistically significant improvement in the patient gait, climbing stairs, locking sensation, squatting, swelling and pain. from these findings, it can be concluded that single-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft using Transpatellar portal viewing can better restore the anterior knee stability.