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Chapter 230Two research questions were formulated:1. Does range of tibial rotation increase after rupture of the anterior cruciate ligament?2. Does ACL reconstruction lead to decreased range of tibial rotation? Material and MethodsIn August 2019 a literature search was performed in the Pubmed database using the search terms: (anterior cruciate ligament[tiab] OR ACL[tiab] OR “Anterior Cruciate Ligament”[Mesh]) AND (“Rotation”[Mesh] OR rotat*[tiab]) AND (“Tibia”[Mesh] OR tibia[tiab] OR tibial[tiab] OR knee[tiab]) NOT (animal NOT human). Next the Embase database was searched using (‘tibia’/exp OR tibia:ab,ti OR tibial:ab,ti OR knee:ab,ti) AND (‘rotation’/exp OR rotat*:ab,ti) AND (‘anterior cruciate ligament’/exp OR ‘anterior cruciate ligament’:ab,ti OR acl:ab,ti NOT (animal NOT human). Duplicates were removed using RefWorks. Titles and abstracts were screened to match the inclusion criteria. Exclusion criteria were as follows:(1) Pivot shift test without quantification of rotational instability(2) newly developed devices to measure tibial rotation, without any form of reference(3) any descriptions other than internal/external rotation in degrees(4) Patients included with concomitant injury to the anterolateral structuresMark Zee.indd 30 03-01-2024 08:56