الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The ACL injury is one of the most common knee injuries especially in the athletes and young active persons , several techniques developed to reconstruct the injured ACL aiming at regain the knee stability hence the knee function and preventing the cartilage and menisci damage and preventing the knee osteoarthritis .( 133)
The used techniques for ACL reconstruction are well developed and efficient in most of the cases ,however in 11% to 30% of cases failure was reported as in literature .(134)
In order to regain the normal knee biomechanics and rotational stability techniques of drilling changed from transtibial to the more anatomical techniques through the anteromedial to make the ACL graft more horizontal rather than being vertical but this was not enough , then double bundle ACL reconstruction technique raised but it’s complex and its efficiency is still debatable , recently the concept of the anterolateral reconstruction has been developed to be combined with the arthroscopic ACL reconstruction to maintain the rotational stability and knee biomechanics .(135)
Many cadaveric studies were carried out to insure the existence and anatomy of the ALL and its biomechanics , these studies approved its presence in about 96% of the population .(124)
It’s attached to the lateral femoral condyle near the attachment of the LCL, and inserts distally on the anterolateral aspect of the tibia midway between the gerdy’s tubercle and the fibular head . this ligament has important role in preventing internal rotation of the knee and the pivot shift .(136)
In those patients having high grade pivot shift if only isolated ACL reconstruction was done the patient will still having rotational instability that can cause farther knee destruction , so combined reconstruction has superior result than the isolated ACL reconstruction that will be suspected to high stresses . (137)
Beside acting to control the knee rotation , the ALL graft found by weight sharing with the ACL graft thus decreasing the loads on the ACL graft and decrease the graft rupture rate .(138)
Some techniques were described for the ALL reconstruction in combination with intraarticular arthroscopic ACL reconstruction one of them is by harvesting a strip of the iliotibial band , which is simple and effective method (130,131)
The aim of this study was to evaluate the knee functional outcomes following combined ACL and ALL reconstruction using hamstring graft (semitendinosus and gracilis tendon )for the ACL reconstruction and central strip about 1cm in width and about 10 cm in length of the iliotibial band for ALL reconstruction .
It was found that this technique improves the objective and subjective results giving better function and stability .
30 patients were operated from October 2020 to July 2021, in a prospective clinical outcome study, thirty patients with a primary diagnosis of ACL tear seen in the outpatient clinic, these patients were evaluated clinically and radiologicaly then they were prepared for combined ACL and ALL reconstruction which were fixed by adjustable loop on the femoral side and biodegradable interference screw on the tibial side for ACL and biodegradable interference screws on femoral side for the ALL graft .
The follow up period was one year , in this period on regular basis after reconstruction was done for one year postoperatively and the scores were reported pre and post op. and at the end of the follow up .
Thirty patients were involved in our study ,21 male and 9 female, 18 of our 30 patient had left sided knee injury while 12 right knee injury . the age of our patient ranged from 19 to 34 years old with mean age 25.9 years old examination, imaging investigation especialy MRI was done and Pre-operative physiotherapy exercises to regain full ROM, normal gait and swelling resolving .
The results pre operative and at the follow up visits post operative and at the end of the follow up and recorded the results by scaling our patients as regard the IKDC objective and subjective scores also the lysholm score . we found marked improvement showed by all the used scores, so our results are in favor and support our believe and concept that favorable outcomes can be achieved with this surgical procedure. This support the importance of the ALL reconstruction to be routinely combined with the ACL reconstruction for patients with high grade pivoting especially whom participate in pivoting sports , undergoing ACL reconstruction.
Our results that indicate better rotational control support the biomechanical studies that demonstrated the great benefit of this technique.( 116,139)
In conclusion from our previous results and the previously described studies we can find that the anterolateral reconstruction using iliotibial band strip accompanying the intraarticular arthroscopic ACL reconstruction provide good reasonable solution for the rotational instability that is found in those patients with high grade pivot shift , with simple technique with easy learning curve , short time , good functional results ,it can improve the rotational stability and reduce the graft rupture rate improving the subjective and objective outcome and the ability to return to the preinjury sport activities , no serious complication was there .
While the study still has some drawbacks like relatively small sample size ,the follow up period not long enough to detect the long term results ,also the absence of randomization .
We recommend further studies for this point with longer follow up period to document the long term results ,also larger sample size.