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Chapter 9180able to expose potential underlying compensatory mechanisms. Also, it exposes the subject not only to a physical but also a mental challenge. There is clearly a strong correlation between psychological readiness to return to sports and knee kinematics, as demonstrated in Chapter 4. We have evidenced that the use of hop tests is of great value when studying knee kinematics after ACL reconstruction. Moreover, combining knee kinematics with hop tests performance can provide even more insight into the status of the individual patient. While cutting and jumping from a stable platform of 40 cm has theoretical advantages of high repeatability, we have shown that performing dynamic hop tests is a safe and reliable way to expose subjects to high amounts of rotational and other forces on the knee. These hop tests are widely used to support the decision for patients to commence return to sports, as explosive power, balance and agility are combined when performing these tests.14,33A downside of the use of hop tests for kinematic analysis of the knee joint could be that they are conducted in a laboratory setting. With the development of augmented reality and the improvements on video performance, future research can focus on actual sport-specific situations. This is important as distraction, double-tasking, anxiety and arousal are factors known to influence athletes’ muscle activity and coordination.19This may very well be a reason why many athletes do not return to sports, despite proper training in the ‘safe’ clinical setting, and even field training. The step towards competitive sports requires not only physical but also psychological readiness. The simple recreation of a string is insufficient to achieve something as complex as return to sports.Rotational laxity one year after ACLRBased on the findings from the first part of this thesis, we have no evidence that persistent rotational laxity in high-demand activities is present one year after ACL reconstruction. It is therefore unlikely for persistent rotational laxity at this timepoint to be hampering return to sports after ACLR. Instead, patients are able to control or compensate for rotational laxity, potentially using neuromuscular adaptations and alterations in landing techniques20 in which also psychological factors play an important role. It seems that one year after ACL reconstruction patients still Mark Zee.indd 180 03-01-2024 08:56