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lateral extra-articular procedures are performed with increasing frequency an ACL injured knees the surgical landmarks are illustrated here Anantara lateral ligament reconstruction is demonstrated here the graft is an isometric being tight an extension where it is able to control the pivot shift and slack in flexion allowing physiological internal rotation and avoiding over constraints in contrast the modified lemare is isometric this means the graft is equally tight throughout the range of motion and therefore has a tendency to restrict physiological internal rotation in flexion you