The arm for controlling rotation (due to its

The presence of high degree positive pivot-shift test result is predictive of a failure to return to the previous level of activity, and poor subjective outcome scores after ACL reconstruction (8).Intra-articular ACL reconstruction is associated with superior quality of life;sports function and knee symptoms when compared to non-operative treatment (9).As the incidence of ACL reconstruction (ACLR) has increased significantly over the past two decades, the revision rates for this procedure has increased alsodue to many causes as graft rupture in young patients participating in pivoting,contact sports, low rates of return to pre-injury levels of sport and persistent rotatory instability, which remain important post-operative clinical issues and represent a significant surgical burden (10-15). Isolated rupture of the ACL causes small increase of internal rotation, so an obvious increase of internal rotation laxity implies damage to the lateral extra articular structures result in persistent anterolateral rotational knee instability (16).Isolated intra-articular ACL reconstruction may be relatively ineffective for controlling internal rotation. Increasing the tension in an isolated ACL graft may lead to over-constraint of anterior translation laxity, yet allow residual rotational abnormality to persist (18).

With some having a residual pivot shift, and increasedtibial internal rotation in gait, and in squatting (19, 20).Interest has been renewed in lateral extra-articular reconstruction in combination with ACLR in the primary setting as a method of potentially reducing the rate of graft failure and thought to mechanically act on the lateral periphery of the joint to provide an increased lever arm for controlling rotation (due to its greater distance from the center of rotation of the knee) than an isolated intra-articular reconstruction and to prevent subluxation of the tibial plateau and hence the knee become more stable (21).

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