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Chapter 244included studies reported if there was any meniscal injury, even though the influence of an intact meniscus on stability is well known.2,25,27Study limitations and future researchThe range of tibial rotation in the context of ACL insufficiency and reconstruction is a challenge which has not been answered yet. Internal and external rotation can only be measured in relation to a neutral position, which can be challenging to determine, especially when using repeated measurements over time. More over the knee demonstrates an internal as well as an external rotation moment during movement. For that reason, in this review only articles reporting the total range of tibial rotation are included. Total range of tibial rotation is of key importance in relating excessive tibial rotation to clinical giving way: an increased internal rotation may not lead to increased laxity when external rotation is reduced. All the included studies lack proper description of the included participants and previous history of the knee. Three studies used randomisation between single bundle and double bundle reconstruction.11,16,20 None of these studies used a blinded observer. Due to the lack of uniformity in measuring techniques and study protocols, only descriptive statistics are provided. Meta-analysis or even providing means and averages is not statistically justified. This review focussed on the role of the ACL in restraining rotational laxity. Other stabilising structures (i.e. iliotibial band, anterolateral ligament etc.) were not taken into account. No further analysis has been performed to evaluate the influence of the type of graft or surgical technique. Considered the presence of a lot of confounding variables, case-matching may be critical in future research to isolate the influence of the ACL on tibial rotation. Clinical recommendationsWhen using CAS for evaluation of tibial rotation the authors would recommend a uniform measuring protocol. Based on findings in Tables 1 and 2, this protocol should contain measurements at 0, 30 and 60 degrees of flexion and a maximum of 5 Nm of rotational force. With more than 60 Mark Zee.indd 44 03-01-2024 08:56