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ACL reconstruction is not the only factor controlling tibial rotation653the supplemental material appendix A over 5-6 times more knee flexion moment is applied to the knee during the SLHD compared to level walking. This is therefore likely the best functional test to mimic sports activities, but in a safe clinical setting. We recommend using hop tests when measuring rTR in the context of ACL injury or after ACLR. Plus, the uniform use of hop tests ensures that studies can be compared.In our study a return to sports rate of four out of seven (57% ) was achieved 12 months after ACL reconstruction which is representative for the recreational athlete according to the literature.3 This emphasizes the lengthy recovery after ACLR. Return to sports within 12 months after ACLR may not be a realistic goal in all patients undergoing ACLR and pre-operative counselling should take this into account. Rehabilitation programmes that include perturbation training, agility training, vision training and sport specific skill training are essential after ACL injury and reconstruction.18 The neuromuscular system adapts to unaccustomed loads, also known as overload.17 Therefore for optimization of the neuromuscular system, changes in volume and intensity of training is needed, as without this, there is no need for the neuromuscular system to improve.17 A periodized rehabilitation program aims to optimize the principle of overload. Rehabilitation planned according to the periodization concepts could allow better integration of the needs of the patients to return to sport.17 When paying special attention to postural control and proprioceptive function of the knee during rehabilitation, significant smaller knee abduction moments were observed compared to traditional rehabilitation programmes, indicating better knee stability. 35Study strengths and limitationsA strength of our study is the fact that we measured rTR in contrast to absolute values of rotation. Other papers focusing on absolute values of tibial rotation showed that ACL-deficient subjects tend towards a more externally rotated tibia.45 It is difficult to repeat the measurements with this method: subsequent measurements with marker placement in a slightly different position with respect to bony landmarks will lead to major differences30, hence in a longitudinal study design the use of absolute values of rotation is not preferred. A relative outcome such as range of Mark Zee.indd 65 03-01-2024 08:56