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General Discussion1779position in the native footprint of the ACL, plus determine the feasibility of an alternative rehabilitation protocol after ACL reconstruction.In Chapter 6 we demonstrated that identification of the femoral footprint of a torn ACL on MRI has a high intraobserver and interobserver reliability. Although the differences were small, it was also demonstrated that orthopaedic surgeons are more consistent in the exact identification of the femoral footprint of the ACL than radiologists. It has been evidenced that identification of an intact ACL is possible on MRI.35,36 Now we have demonstrated that it is also feasible to identify the femoral footprint of a torn ACL.Based on the results of the research in Chapter 6 we were able to create and use a patient-specific guide for a patient-specific reconstruction of the ACL. Based on a routine clinical MRI of a patient, a 3D model of the femur was created and a femoral tunnel position was planned. Next, a patient-specific guide was designed that fits the intercondylar notch to ensure the femoral tunnel position. Chapter 7 shows the in vitro results of the newly developed guide. Although we need further improvement in the design to increase accuracy, the concept of a patient-specific guide seems promising.In Chapter 8 we present a novel rehabilitation protocol – Knee Rehabilitation on Skates (KROS) – to be used in patients after ACL reconstruction. Compliance with rehabilitation is a precondition for better return to sports rates after ACL reconstruction.2 The current Dutch guideline on rehabilitation after ACL reconstruction mainly focuses on strength exercises, but allows room for interpretation.40 In order to prevent potential dullness and monotony of rehabilitation after ACL reconstruction, it is important to compose an individualised rehabilitation programme that meets the patient’s needs and wishes, within evidence-based boundaries. With the development of the KROS protocol we strove to offer an alternative for patients who do not necessarily participate in pivoting sports. Even though the COVID pandemic affected this study, the results of this pilot study are promising. This study has shown that it is feasible to introduce ice speed skating in the rehabilitation after ACL reconstruction, which may Mark Zee.indd 177 03-01-2024 08:56