title: Excessive tibial rotation during high-demand activities is not restored by anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  Recent in vitro research has suggested that anterior cruciate ligament (ACL) reconstruction does not restore control of tibial rotation. The purpose of this study was to explore these findings in vivo and investigate rotational knee stability during landing and subsequent pivoting. Such an activity places higher demands on the knee, almost similar to those found during high-level sports.
  
  
  METHODS
  Case control series study.
  
  
  METHODS
  We assessed 11 patients who had undergone ACL reconstruction with the same arthroscopic technique using a bone-patellar tendon-bone graft, 11 ACL-deficient subjects who had sustained the injury more than 1 year prior to testing, and 11 matched controls. Kinematic data were collected (50 Hz) with a 6-camera optoelectronic system while the subjects performed the following task: they jumped off a 40-cm platform and landed on the ground. After foot contact, the subjects were instructed to pivot at 90 degrees and walk away from the platform. The evaluation period was identified from initial foot contact with the ground with both legs, included the pivoting of the ipsilateral leg, and was completed on touchdown of the contralateral leg.
  
  
  RESULTS
  Significant differences were found between the reconstructed leg of the ACL group and the healthy control, and between the deficient leg of the ACL-deficient group and the healthy control. We also found no significant differences between the deficient leg of the ACL-deficient group and the reconstructed leg of the ACL reconstructed group.
  
  
  CONCLUSIONS
  It was concluded that, under high-stress activities, ACL reconstruction may not restore tibial rotation to the previous physiological level, even though anterior tibial translation is restored. Future research on ACL reconstruction should focus on the development of new surgical procedures and/or grafts to address this problem.
  
  
  METHODS
  Level III.
authors.affiliation: Orthopaedic Sports Medicine Center of Ioannina, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Ristanis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Stergiou
authors.forename: Kostas
authors.initials: K
authors.lastname: Patras
authors.forename: Haris S
authors.initials: HS
authors.lastname: Vasiliadis
authors.forename: Giannis
authors.initials: G
authors.lastname: Giakas
authors.forename: Anastasios D
authors.initials: AD
authors.lastname: Georgoulis
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D016022:Case-Control Studies; D005260:Female; D005269:Femur / Q000601:surgery / Q000637:transplantation; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D017847:Patellar Ligament / Q000637:transplantation; D020127:Recovery of Function; D012399:Rotation; D013977:Tibia / Q000601:surgery / Q000637:transplantation; D000070600:Tibial Meniscus Injuries; D016896:Treatment Outcome