ABSTRACT Background: The use of extra-articular tenodesis procedures in combination with ACL reconstruction improves the anterolateral knee stability thus improving both pa- tients’ satisfaction and patients’ ability to return to the pre-injury level of athletic ac- tivity. Methods: 46 patients complaining of complete ACL tear with grade II or III pivot shift were selected. Patients were divided into two groups randomly according to sur- geon and patient preference. Group A; surgical interference was done in form of arthroscopic anatomic single bundle ACL reconstruction using hamstring autograft. Group B; surgical interference was done in form of Arthroscopic anatomic single bundle ACL reconstruction using hamstring autograft augmented by extra-articular tenodesis using a strip from the Iliotibial tract. Results: Group A patients showed improvement of the mean Modified Cincinnati knee rating system from fair 40.7 points to excellent 84.7 points. The improvement was significant at p < .05. Also the mean post-operative Tegner and Lysholm knee scoring scale improved poor 45.27 points to good 85 points this improvement was significant at p < .05. Eighteen patients (81.8%) were satisfied by the results. In Group B patients, the mean post-operative Modified Cincinnati knee rating system improved from fair 41 points excellent 88.5 points the improvement was significant at p < .05. Also the mean post-operative Tegner and Lysholm knee scoring scale im- proved poor 47.08 points to good 88.6 points the improvement was significant at p < . 05. Twenty-three patients (95.84%) were satisfied by the results. Comparison be- tween both groups showed improved outcome in Group B patients treated with com- bined extra-articular tenodesis and intra-articular reconstruction. Conclusion: Augmentation of ACL reconstruction using lateral extra-articular ten- odesis is an important option to improve knee rotational stability and functional out- come in grade II and III pivot shift ACL deficient knees.