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Chapter 9182Individualising ACL ReconstructionEven though it is recognised that one size does not fit all,23 current surgical techniques still seem to fall short in providing a reproducible, anatomic result. This is reflected by the altered knee kinematics as shown in this thesis. Apparently, even when using an ‘anatomic’ ACL reconstruction, native knee kinematics are poorly restored.13 This may be because during ACL reconstructive surgery it is hard for the surgeon to identify the exact position of the femoral footprint of the ACL, resulting in an estimated bestguess for the location of the femoral tunnel. The ensuing non-anatomic ACL graft placement leads to altered knee biomechanics and poor subjective knee function. We must strive for anatomic ACL reconstruction to restore native knee biomechanics, taking the demonstrated individual variations into account.28With increasing understanding of the anatomy and biology of the ACL,22true anatomic ACL reconstruction comes within reach.23 A patient-specific guide can help attain this result. Also, hypothetically speaking a true anatomic ACL reconstruction can induce positive feedback to the central nervous system, which in turn can promote pre-injury neuromuscular functioning.In recent years attention has shifted back to ACL repair due to the success of arthroscopic suturing techniques. For these techniques it is at least as important to recognise the femoral footprint of the ACL, since a femoral tunnel is created to secure the sutures. A possible advantage is the short interval between ACL injury and repair, which is preferentially within 3-4 weeks post-injury.17,39 This may assist visualisation of the femoral footprint. Another theoretical benefit of ACL repair is preservation of the native ACL fibres, including proprioceptive function.39,43 This may help regain biomechanical feedback to the central nervous system. The same is strived for using ACL remnant-preserving reconstruction.7 In both techniques it remains vital to guarantee an anatomic reconstruction – with or without use of a patient-specific guide – to ensure native biomechanics of the knee. While these techniques evolve over time, recognising the importance of neurogenic feedback is important. Unfortunately, despite Mark Zee.indd 182 03-01-2024 08:56