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The purpose of this study was to compare the tibiofemoral kinematics of ACL\u2010deficient knees to healthy contralateral ones during the execution of weight\u2010bearing activities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eight patients with isolated ACL injury and healthy contralateral knees were included in the study. Patients were asked to perform a single step forward and a single leg squat first with the injured knee and then with the contralateral one. Knee motion was determined using a validated model\u2010based tracking process that matched subject\u2010specific MRI bone models to dynamic biplane radiographic images, under the principles of Roentgen stereophotogrammetric analysis (RSA). Data processing was performed in a specific software developed in Matlab.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Statistically significant differences (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) were found for single leg squat along the frontal plane: ACL\u2010deficient knees showed a more varus angle, especially at the highest knee flexion angles (40\u00b0\u201350\u00b0 on average), compared to the contralateral knees. Furthermore, ACL\u2010deficient knees showed tibial medialization along the entire task, while contralateral knees were always laterally aligned. This difference became statistically relevant (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05) for knee flexion angles included between 0\u00b0 and about 30\u00b0.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ACL\u2010deficient knees showed an abnormal tibial medialization and increased varus angle during single leg squat when compared to the contralateral knees. These biomechanical anomalies could cause a different force distribution on tibial plateau, explaining the higher risk of early osteoarthritis in ACL deficiency. The clinical relevance of this study is that also safe activities used in ACL rehabilitation protocols are significantly altered in ACL deficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-020-05979-6","type":"journal-article","created":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T09:03:24Z","timestamp":1586163804000},"page":"389-397","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["ACL deficiency influences medio\u2010lateral tibial alignment and knee varus\u2013valgus during in vivo activities"],"prefix":"10.1002","volume":"29","author":[{"given":"Piero","family":"Agostinone","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Clinica Ortopedica e Traumatologica II IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Di Paolo","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM Universit\u00e0 di Bologna Via Giulio Cesare Pupilli, 1 40136 Bologna BO Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Grassi","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Clinica Ortopedica e Traumatologica II IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Pinelli","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Dipartimento di Scienze per la Qualit\u00e0 della Vita QuVi Universit\u00e0 di Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bontempi","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Laboratorio di Biomeccanica ed Innovazione Tecnologica IRCSS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Bragonzoni","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Dipartimento di Scienze per la Qualit\u00e0 della Vita QuVi Universit\u00e0 di Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Zaffagnini","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Clinica Ortopedica e Traumatologica II IRCCS Istituto Ortopedico Rizzoli Bologna Italy"},{"name":"<!--<label>2<\/label>--> Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM Universit\u00e0 di Bologna Via Giulio Cesare Pupilli, 1 40136 Bologna BO Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,4,6]]},"reference":[{"key":"e_1_2_10_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2004.02.010"},{"key":"e_1_2_10_3_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.01408"},{"key":"e_1_2_10_4_2","doi-asserted-by":"crossref","unstructured":"BontempiM Roberti di SarsinaT Marcheggiani MuccioliGM PizzaN CardinaleU BragonzoniL ZaffagniniSJ\u2010curve design total knee arthroplasty: the posterior stabilized shows wider medial pivot compared to the cruciate retaining during chair raising.Knee Surg Sports Traumatol Arthrosc(2019)10.1007\/s00167\u2010019\u201005645\u2010631377823","DOI":"10.1007\/s00167-019-05645-6"},{"key":"e_1_2_10_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010018\u20105243\u20105"},{"key":"e_1_2_10_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546506287299"},{"key":"e_1_2_10_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510365531"},{"key":"e_1_2_10_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0020\u20101383(90)90130\u2010M"},{"key":"e_1_2_10_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2016.01.041"},{"key":"e_1_2_10_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2009.11.006"},{"key":"e_1_2_10_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465030310012401"},{"key":"e_1_2_10_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2019.06.012"},{"key":"e_1_2_10_13_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623\u2010198163080\u201000007"},{"key":"e_1_2_10_14_2","doi-asserted-by":"publisher","DOI":"10.1115\/1.3138397"},{"key":"e_1_2_10_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010012\u20102761\u20101"},{"key":"e_1_2_10_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.20440"},{"key":"e_1_2_10_17_2","unstructured":"ISO 5725\u20101:1994(en) Accuracy (trueness and precision) of measurement methods and results\u2014part 1: General principles and definitions.https:\/\/www.iso.org\/obp\/ui\/#iso:std:iso:5725:\u20101:en. 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