الفهرس 
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Abstract
The anterior cruciate ligament injuries are the commonest sports knee injury. The main surgical treatment that was utilized in the last decades was the non-anatomical or so called isometric single bundle ACL reconstruction, which in spite of its satisfactory results, did not prevent the occurrence of osteoarthritis in the knee joint. Additionally, 10% -30% of the patients did not return to the pre-operative level of activity.
The anatomic single bundle and double bundle ACL reconstruction was developed to restore the native anatomic attachment and tension pattern of the ACL and hence restore the ACL function in preventing not only the AP instability but also the rotational instability of the knee as well. The literatures report better outcomes with the anatomic reconstruction than the non-anatomic reconstruction.
The aim of the current study was to compare the effectiveness of arthroscopic anatomic single bundle and anatomic double bundle ACL reconstruction techniques in restoring normal Knee stability, to evaluate whether the double bundle ACL reconstruction reduces the risk of osteoarthritis as well as to assess the complication rates after single and double bundle ACL reconstruction.
The study was divided into 3 parts:
The cadaveric part: in this part of the study we evaluated the inclination angles of the native ACL bundles in relation to the tibial plateau to evaluate the possibility to drill the femoral tunnels transtibially. In this part we found that the mean inclination angle of the AM bundle was 55.5° in the sagittal plane and 80.6° in the coronal plane. The PL bundle showed an inclination angle of 90.6° and 81.3° in the sagittal and the coronal planes respectively. Accordingly, we found that the drilling of the PL femoral tunnel transtibially is not possible.
The Pilot study: the aim of this part of the study was to standardize the surgical technique of double bundle ACL reconstruction used in the third part of the study. we carried out the double bundle reconstruction on 11 Patients. With a mean operative time of 78 minutes. One double bundle reconstruction was aborted and managed as single bundle due to cut short of the hamstring graft. None of the patients developed early post-operative complication and all patients regained full range of movement at an average of 2 months post-operatively.
the prospective randomized study to compare the single and double bundle reconstruction: in this part of the study we reconstructed the ACL in 60 patients randomly using either the single bundle or the double bundle technique. 30 patients were assigned in each group. the patients were followed up till the longest possible period. Which was about 8 years in both patients group respectively. 8 complications were encountered in 7 patients. Of these 5 in the double bundle group and 2 in the single bundle group. re-surgery was required in 2 patients in the single bundle group and 5 patients in the double bundle group. we lost 15 % of the patients because of the long term follow up.
We found that there was no statistically significant difference between the single and double bundle group regarding the patients’ satisfaction, subjective knee scores or the return to the preoperative level of activities. The clinical evaluation revealed that the double bundle reconstruction provided a better AP stability than the single bundle group but not rotational stability. The radiological evaluation revealed that both the single and double bundle did not prevent the development of osteoarthritis in the operated knees.
CT scan was carried out for a group of patients in the single bundle and double bundle group and we found that the femoral tunnels in the double bundle groups were located non anatomically. The tunnels in the single bundle group were nearer to the recommended anatomical location
We concluded that The ACL reconstruction in our hands regardless of the techniques carries satisfaction rate of 88%. The technique used for the single bundle is more approximating the anatomic reconstruction than the double bundle. In spite of being statistically insignificant there is a higher rate of complications and re-surgery in the double bundle compared with the single bundle groups. Additionally, the double bundle ACL reconstruction implies double cost of the implant. Accordingly, we recommend the use of the single bundle reconstruction technique.