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1Introduction21Outline of the thesisThe first question to be answered is whether there is evidence that ACL reconstruction can indeed reduce the increased range of tibial rotation which is present in the ACL-deficient knee. Chapter 2 reports on a literature review to quantify the role of ACL reconstruction in limiting the range of tibial rotation. The study focuses on the passive range of tibial rotation in the anaesthetised patient, and thus investigates the mere mechanical impact of the ACL graft. The next question, reported in Chapter 3, is whether increased range of tibial rotation can be measured during highdemand activities in the ACL-deficient knee and what the effect of an ACL reconstruction is on this range of tibial rotation.We hypothesise that when the range of tibial rotation is greater, poorer subjective knee function and poorer psychological readiness are present. In Chapter 4 a study is presented on the correlation between objective range of tibial rotation and both subjective knee function and psychological readiness. To this end, we conducted a study imitating a real in-sports knee landing. Furthermore, the hypothesis that a steeper posterior tibial slope, especially in the lateral compartment of the knee, increases the range of tibial rotation will be tested. Chapter 5 examines the correlation between range of tibial rotation during high-demand tasks and amount of posterior tibial slope.To develop an accurate patient-specific guide to create a femoral tunnel at the anatomic origin of the native ACL during ACL reconstruction, we must first identify the native origin of a torn ACL on MRI. In Chapter 6 we determined the intraobserver and interobserver reliability of determining the femoral footprint of the torn ACL on MRI scans. The knowledge gained in Chapter 6 was instrumental towards developing this guide, and in Chapter 7 the first in vitro results are presented on its accuracy.Besides improving to individualise the surgical technique, tailoring the rehabilitation may be an important adjunct to improve return to sports outcomes after ACL reconstruction. Some patients may benefit from an alternative to the current available rehabilitation programmes, depending Mark Zee.indd 21 03-01-2024 08:56