Page 36 - Demo

Chapter 234the groups. Postoperative the AMP group showed a significant difference regarding the improvement of absolute values of internal rotation (AMP: 4.9 deg, TT: 3.8deg, p = 0.016). However in terms of range of tibial rotation no difference is observed. Both techniques reduces the amount of total tibial rotation by 19%.22 See tables 1 and 2.Other measuring methodsThree more studies were retrieved studying tibial rotation after ACL reconstruction.16,18,26 Hemmerich16 used MRI to evaluate tibial rotation where Nordt26 used CT scans. Both applied a 5Nm torque. Kidera18 acquired 3D CT and biplanar fluoroscopy during squatting to evaluate tibial rotation after double bundle ACL reconstruction. This is the same technique as used by Miyaji23 to study ACL Deficient subjects. A decrease in range of tibial rotation of 13.5% after ACLR is shown by Kidera, although this did not reach statistical significance. In this study, no significant difference between the injured and contralateral intact leg was reported. (14,9 and 14,5 degrees respectively). Both studies of Nordt and Kidera are graded to have a serious risk of selection and confounding bias. See Figure 2.Overall rating of quality of evidenceThe majority of included studies were observational studies. Only four randomized controlled trials were included. According to the GRADE classification14 the overall quality can be rated as low to very low. This is based on inconsistencies, imprecisions and risk of bias.An overview of the quality assessment of the included trials is provided in Figures 2 and 3.Evidence statements according to GRADEVery Low Evidence: ACL rupture leads to increase of range of tibial rotation.Low Evidence: ACL reconstruction leads to decrease of range of tibial rotation in relation to the injured state.Mark Zee.indd 34 03-01-2024 08:56