TY - JOUR
T1 - Management of anterior cruciate ligament revision in adults
T2 - the 2022 ESSKA consensus part III—indications for different clinical scenarios using the RAND/UCLA appropriateness method
AU - Tischer, Thomas
AU - Andriolo, Luca
AU - Beaufils, Philippe
AU - Ahmad, Sufian S.
AU - Bait, Corrado
AU - Bonomo, Marco
AU - Cavaignac, Etienne
AU - Cristiani, Riccardo
AU - Feucht, Matthias J.
AU - Fiodorovas, Markas
AU - Grassi, Alberto
AU - Helmerhorst, Gijs
AU - Hoser, Christian
AU - Karahan, Mustafa
AU - Komnos, George
AU - Lagae, Koen Carl
AU - Madonna, Vincenzo
AU - Monaco, Edoardo
AU - Monllau, Juan Carlos
AU - Ollivier, Matthieu
AU - Ovaska, Mikko
AU - Petersen, Wolf
AU - Piontek, Tomasz
AU - Robinson, James
AU - Samuelsson, Kristian
AU - Scheffler, Sven
AU - Sonnery-Cottet, Bertrand
AU - Filardo, Giuseppe
AU - Condello, Vincenzo
N1 - Funding Information: To all members of the steering group (Roland Becker, David Dejour, Karl Eriksson, Adrian Wilson, Marc Strauss, Romain Seil, Jaques Menetrey, Nicolas Pujol and Martin Rathcke) and the ESSKA office (special thanks to Anna Hansen-Rak for administrative support and to Judy C Mac Donald for proofreading) as well as the peer reviewers of the affiliated national societies (BAKAST, BKS, AOTBIH, CSSTA, SAKS, EASTS, FAKA, SFA, GASSA, AGA, GOTS, DKG, HAA, SIAGASCOT, LAKAS, LIROMS, NVA, NAA, PTA, SPAT, SPOT, SRATS, ASTAOR, RKA, ASTAS, SSASST, SEROD, AEA, SETRADE, SFAIM, TUSYAD and BOSTAA) for their review. Publisher Copyright: © 2023, The Author(s).
PY - 2023/11
Y1 - 2023/11
N2 - Purpose: The aim of the ESSKA 2022 consensus Part III was to develop patient-focused, contemporary, evidence-based, guidelines on the indications for revision anterior cruciate ligament surgery (ACLRev). Methods: The RAND/UCLA Appropriateness Method (RAM) was used to provide recommendations on the appropriateness of surgical treatment versus conservative treatment in different clinical scenarios based on current scientific evidence in conjunction with expert opinion. A core panel defined the clinical scenarios with a moderator and then guided a panel of 17 voting experts through the RAM tasks. Through a two-step voting process, the panel established a consensus as to the appropriateness of ACLRev for each scenario based on a nine-point Likert scale (in which a score in the range 1–3 was considered ‘inappropriate’, 4–6 ‘uncertain’, and 7–9 ‘appropriate’). Results: The criteria used to define the scenarios were: age (18–35 years vs 36–50 years vs 51–60 years), sports activity and expectation (Tegner 0–3 vs 4–6 vs 7–10), instability symptoms (yes vs no), meniscus status (functional vs repairable vs non-functional meniscus), and osteoarthritis (OA) (Kellgren–Lawrence [KL] grade 0–I–II vs grade III). Based on these variables, a set of 108 clinical scenarios was developed. ACLRev was considered appropriate in 58%, inappropriate in 12% (meaning conservative treatment is indicated), and uncertain in 30%. Experts considered ACLRev appropriate for patients with instability symptoms, aged ≤ 50 years, regardless of sports activity level, meniscus status, and OA grade. Results were much more controversial in patients without instability symptoms, while higher inappropriateness was related to scenarios with older age (51–60 years), low sporting expectation, non-functional meniscus, and knee OA (KL III). Conclusion: This expert consensus establishes guidelines as to the appropriateness of ACLRev based on defined criteria and provides a useful reference for clinical practice in determining treatment indications. Level of evidence: II.
AB - Purpose: The aim of the ESSKA 2022 consensus Part III was to develop patient-focused, contemporary, evidence-based, guidelines on the indications for revision anterior cruciate ligament surgery (ACLRev). Methods: The RAND/UCLA Appropriateness Method (RAM) was used to provide recommendations on the appropriateness of surgical treatment versus conservative treatment in different clinical scenarios based on current scientific evidence in conjunction with expert opinion. A core panel defined the clinical scenarios with a moderator and then guided a panel of 17 voting experts through the RAM tasks. Through a two-step voting process, the panel established a consensus as to the appropriateness of ACLRev for each scenario based on a nine-point Likert scale (in which a score in the range 1–3 was considered ‘inappropriate’, 4–6 ‘uncertain’, and 7–9 ‘appropriate’). Results: The criteria used to define the scenarios were: age (18–35 years vs 36–50 years vs 51–60 years), sports activity and expectation (Tegner 0–3 vs 4–6 vs 7–10), instability symptoms (yes vs no), meniscus status (functional vs repairable vs non-functional meniscus), and osteoarthritis (OA) (Kellgren–Lawrence [KL] grade 0–I–II vs grade III). Based on these variables, a set of 108 clinical scenarios was developed. ACLRev was considered appropriate in 58%, inappropriate in 12% (meaning conservative treatment is indicated), and uncertain in 30%. Experts considered ACLRev appropriate for patients with instability symptoms, aged ≤ 50 years, regardless of sports activity level, meniscus status, and OA grade. Results were much more controversial in patients without instability symptoms, while higher inappropriateness was related to scenarios with older age (51–60 years), low sporting expectation, non-functional meniscus, and knee OA (KL III). Conclusion: This expert consensus establishes guidelines as to the appropriateness of ACLRev based on defined criteria and provides a useful reference for clinical practice in determining treatment indications. Level of evidence: II.
KW - Anterior cruciate ligament
KW - Consensus
KW - Guidelines
KW - Knee
KW - Revision
UR - http://www.scopus.com/inward/record.url?scp=85158151055&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00167-023-07401-3
DO - https://doi.org/10.1007/s00167-023-07401-3
M3 - Article
C2 - 37133742
SN - 0942-2056
VL - 31
SP - 4662
EP - 4672
JO - Knee surgery, sports traumatology, arthroscopy
JF - Knee surgery, sports traumatology, arthroscopy
IS - 11
ER -