الفهرس 
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Abstract
Anterior cruciate ligament injury is one of the most frequent injuries in athletes with a reported prevalence of around 68.6/100,000 per year. ACLR is one of the most commonly performed orthopaedic procedures. An ACL-deficient knee shows an anterior laxity and a variable degree of associated rotational instability.
The ACL consists of 2 functional bundles, namely the anteromedial (AM) and posterolateral (PL) bundles, each named for their respective insertion site locations on the tibia. The bundles become evident during development of the fetus and are differentiable throughout life. A septum of connective tissue divides the AM and PL bundles, which provides a blood supply to the ligament and allows the bundles to work synergistically throughout motion.
A variable injury to the lateral capsule-ligamentous structures has been hypothesized in the onset of rotational laxity. Historically, anterior laxity in ACL-deficient knees was surgically treated with isolated extra-articular tenodesis, as described by Lemaire or MacIntosh. This procedure was effective in reducing the rotation of the tibial plateau relative to the femur; however, isolated extra-articular reconstructions provided only moderate control of anterior laxity. In addition, the overall long-term results of these procedures were poor and only few patients reported good to excellent results. The main drawback of these techniques is that they are non-anatomic and do not restore the function of the ACL in preventing ATT.
Unfortunately, up to date there is no clear evidence of better control of rotational laxity. Rotational instability has been related to the injury and loss of function of the antero-lateral structures with the ALL receiving increasing interest in recent years.
Persistent anterolateral rotary instability of the knee as measured by pivot-shift testing is associated with worse functional outcomes in patients who have undergone ACLR surgery. In such cases, augmentation of an ACLR with anterolateral procedures can be a good option.
This lesion has been shown to be present in the vast majority of acute ACL injuries and its presence is associated with significantly increased rotational knee laxity. In order to improve the control of pivoting phenomenon in patients with antero-lateral capsule injury, some surgeons have started using the addition of an anterolateral procedures to the standard intra-articular ACLR. Nowadays either ALLR or LET is recommended only in patients showing explosive rotatory instability with pivot shift 3+.
Sixteen patients whom included in this study were diagnosed to have an isolated ACL injury. Patients were classified into 2 groups according to the technique of surgical treatment they will receive. Thirty patients had arthroscopic ACLR with ALLR while thirty patients received their treatment in the form of ACLR with LET.
For all patients, conventional radiographs and MRI of the knee were done to confirm ACL injury and roll out any ligamentous or meniscal injuries.
The International Knee Documentation Committee (IKDC), Lysholm knee score, Anterior Drawer, Lachman and pivot shift tests were used to evaluate patient physical activity pre- and post-operatively.
Patients were followed-up for at least 24 months after the operative procedure.
The mean duration of follow up in our series was 18 months ± 3.7 (Range, 24 – 36). patients were 55 males and 5 females in the series with mean age of 28.7 ± 6.8 (Range, 18 – 40). There were 45 dominant (75%) and 15 non dominant (25%) side. The mean duration from the time of injury to surgery was 28.7 ± 6.8 (Range, 18 – 40).
from all the 60 patients, 38 had their ACL torn from non-contact injury (63.3%), while the other 22 (36.7 %) patients faced contact injury. As regards type of sport 42 patient had recreational type (70%) while 18 ones were professional (30%).
There was a statistically significant difference between two groups as regarding surgical time, in group A the mean surgical time was 70.1 ± 5 minutes, ranging between 60 and 81 minutes, and 60 ± 5.9 minutes, ranging between 50 and 69 minutes in group B (P = 0.001).
Both groups were compared postoperatively at 3, 6, 12, 24 and 36 months.
After 3 months the IKDC score in group A was 80.6 +/- 5.9 while in group B the IKDC score was 77.7 +/- 6.1 with (P value 0.061) which is statistically insignificant. At the end of follow up the IKDC score in group A had a postoperative score of 92.3+/- 4.3, while in group B was found to have a postoperative score of 90,5+/- 8.2 which was statistically insignificant (P 0.096).
After 3 months the Lysholm score in group A was 84.3 +/- 6.4 while in group B the Lysholm score was 85.3 +/- 8.7 with (P value 0.628) which is statistically insignificant. At the end of follow up Lysholm score in group A had a postoperative score of 91.9+/- 6.1, while in group B was found to have a postoperative score of 90.4+/- 8.7 which was statistically insignificant (P 0.073)
After 3 months the pivot shift test in group A was 96.7% grade zero and 3.3 grade one while in group B was 93.3% grade zero and 6.7 grade one with (P value 0.197) which is statistically insignificant. At the end of follow up was the same result.
We had one patient from group A suffering from rupture as a result of direct contact trauma after one year from surgery and also one patient from group B who experienced a new non-contact knee injury after 4 months, he has grade 2 Pivot shift. Thay will need a revision surgery.