Page 31 - Demo

A review on range of tibial rotation292IntroductionA rupture of the anterior cruciate ligament (ACL) is a common sports injury, often leading to prolonged absence or even cessation of sports activities. Next to its primary role in restraining anterior tibial translation, the ACL is an important factor in the rotational stability of the knee.4,7Although the current practice supports reconstruction as an important factor in returning to sports activities, and good results after transtibial ACL reconstruction are generally achieved,1,5 a large group of patients still reports residual laxity in the form of ‘giving way’ and/or a positive pivot shift.1 In order to address this phenomenon the double bundle reconstruction technique and the ‘anatomic’ reconstruction technique have been developed. Both techniques show in vitro better control of rotational laxity.28,30 In recent years accessory extra-articular stabilizing techniques (e.g. ALL reconstruction, Lemaire procedure etc.) have been re-introduced to better control rotational laxity. However, a scientific basis to support this trend is lacking.In vivo, the available studies only use subjective tests to measure the amount of postoperative rotational laxity (e.g. pivot shift). As no generally accepted gold standard for measuring tibial rotation exists, comparing outcomes between studies is not possible . The conclusions and outcomes on the amount and the direction of tibial rotation in ACL deficiency and after ACL reconstruction are contradicting. As well increased internal rotation as increased external rotation have been reported. This leads to inconclusive results. The authors aim to set the first step in developing a standard, valid and reproducible protocol for measuring tibial rotation. The purpose of this systematic review is to create an overview of the influence of the reconstructed ACL on, objectively measured, tibial rotation. Mark Zee.indd 29 03-01-2024 08:56