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A review on range of tibial rotation332evaluate knee kinematics in ACL deficient subjects. Grassi tried to link the kinematic pattern, acquired by CAS, to bony morphology, which was evaluated by MRI. An indirect correlation between the lateral posterior tibial slope and rotational laxity was presented.13Patients after ACL reconstructionNine studies were retrieved in which ACL reconstructed knees were analysed for the range of tibial rotation. In six ACLR studies a CAS system was used during surgery to perform pre- and postoperative measurements. Three studies were classified as “other evaluation method”. See table 4 and 5.Computer Assisted Surgery (CAS)In six studies, during ACL reconstruction, the CAS software was used to measure range of tibial rotation before and after reconstruction of the ACL.9-12,20 In all of these studies, a manual force was applied in order to rotate the tibia. Maximum internal and external rotations were applied to the foot of the anesthetized patient and associated values of maximum internal and external rotation of the knee were recorded. All studies showed a reduction of total range of tibial rotation of 17-32% after ACL reconstruction. See Tables 1 and 2. Two studies compared single bundle reconstruction with double bundle reconstructions.11,20 In one study by Debieux, no significant difference regarding range of tibial rotation between the two techniques was detected.11 The other study by Lee20 showed less total rotation when performing double bundle reconstruction compared to single bundle at 30 and 60 degrees of flexion. Apart from the fact that amount of the applied force rotation was not recorded, all of these studies using CAS were graded to have a moderate to severe risk of bias in selection of subjects and/or confounding. See Figures 2 and 3.Minguell was the only one to perform a study randomizing between a anteromedial portal technique (AMP) and a transtibial drilling technique (TT) to create the femoral tunnel.22 The AMP group showed a more anatomic positioning of the graft in both sagittal and coronal planes. Preoperative there was no differences in range of tibial rotation between Mark Zee.indd 33 03-01-2024 08:56