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ACL reconstruction is not the only factor controlling tibial rotation673Despite these limitations, in these patients we have objectively measured that rTR in the ACL-deficient knee is not greater than in the contralateral ACL-intact knee shortly after ACL injury. Further research is needed to elucidate why rTR is not higher or even lower in acute ACL injury. Up to now we have found no evidence to suggest that persistent increased rotational laxity hampers return to play after ACLR. Special attention to neuromuscular control, subjective knee function and psychological factors may help us better understand which factors play an important role in whether objective knee instability occurs, which ultimately may hamper return to sports rates. In this light, testing subjects in circumstances that replicate sport activities, i.e. using hoptests, is crucial. ConclusionNo increase in range of tibial rotation is shown in subacute ACL-injured knees compared to contralateralal intact knees during high demand tasks. One year after ACL reconstruction, a smaller range of tibial rotation is observed compared to ACL-intact knees. Further research into altered motor control strategies and psychological factors like fear of re-injury could elucidate this unexpected phenomenon. We propose the use of hop tests as high-demand, complex tasks when evaluating range of tibial rotation both before and after ACL reconstruction.DeclarationsEthical Approval statementThe study protocol was reviewed and approved by the Institutional Review Board of University Medical Center Groningen (registration ID 2015/524, UMCG trial register no. 201501098). The trial was registered in the Dutch Trial Register (NTR: www.trialregister.nl, registration ID NL7686).Informed Consent statementInformed consent was obtained from all individual participants included in the study. The authors affirm that human research participants provided Mark Zee.indd 67 03-01-2024 08:56