Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus part I-diagnostics and preoperative planning

Thomas Tischer; Philippe Beaufilis; Roland Becker; Sufian S Ahmad; Marco Bonomo; David Dejour; Karl Eriksson; Giuseppe Filardo; Matthias J Feucht; Alberto Grassi; Adrian Wilson; Jacques Menetrey; Nicolas Pujol; Martin Rathcke; Romain Seil; Marc J Strauss; Vincenzo Condello

doi:10.1007/s00167-022-07214-w

Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus part I-diagnostics and preoperative planning

Knee Surg Sports Traumatol Arthrosc. 2023 Nov;31(11):4642-4651. doi: 10.1007/s00167-022-07214-w. Epub 2022 Nov 2.

Authors

Thomas Tischer^{1

2}, Philippe Beaufilis³, Roland Becker⁴, Sufian S Ahmad⁵, Marco Bonomo⁶, David Dejour⁷, Karl Eriksson⁸, Giuseppe Filardo^{9

10}, Matthias J Feucht^{11

12}, Alberto Grassi¹³, Adrian Wilson¹⁴, Jacques Menetrey^{15

16}, Nicolas Pujol¹⁷, Martin Rathcke¹⁸, Romain Seil¹⁹, Marc J Strauss²⁰, Vincenzo Condello²¹

Affiliations

¹ Klinik für Orthopädie und Unfallchirurgie, Malteser Waldkrankenhaus St. Marien, Rathsberger Straße 57, 91054, Erlangen, Germany. thomas.tischer@waldkrankenhaus.de.
² Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany. thomas.tischer@waldkrankenhaus.de.
³ ESSKA Consensus Projects Advisor, Versailles, France.
⁴ Centre of Orthopaedic and Traumatology, University of Brandenburg an Der Havel, Brandenburg, Germany.
⁵ Department of Orthopaedic Surgery of the Medical School of Hannover MHH, Annastift Hospital, Hannover, Germany.
⁶ Dipartimento di Ortopedia e Traumatologia, IRCCS Ospedale Sacro Cuore don Calabria, Negrar, VR, Italy.
⁷ Lyon Ortho Clinic, Clinique de la sauvegarde Ramsay Santé, 29 avenue des sources, Lyon, France.
⁸ Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden.
⁹ Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
¹⁰ Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
¹¹ Department of Orthopaedic Surgery Paulinenhilfe, Diakonie Klinikum, Stuttgart, Germany.
¹² Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
¹³ II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
¹⁴ Orthopaedic Specialist Group, Harley Street Specialist Hospital, Queen Anne St, London, UK.
¹⁵ Center of Sports Medicine and Exercise, Hirslanden Clinique La Colline, Geneva, Switzerland.
¹⁶ Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland.
¹⁷ Department of Orthopaedic and Trauma Surgery, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France.
¹⁸ Department of Orthopaedics and Sports traumatology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
¹⁹ Department of Orthopaedic Surgery, Centre Hospitalier-Clinique d'Eich and Luxembourg Institute of Health, Luxembourg, Luxembourg.
²⁰ Idrettens Helsesenter, Oslo, Norway.
²¹ Joint Preservation and Reconstructive Surgery and Sports Medicine Unit, Humanitas Castelli Clinic, Bergamo, Italy.

PMID: 36322180
DOI: 10.1007/s00167-022-07214-w

Abstract

Purpose: The aim of this ESSKA consensus is to give recommendations based on evidence and expert opinion to improve diagnosis, preoperative planning, indication and surgical strategy in ACL revision.

Methods: The European expert surgeons and scientists were divided into four groups to participate in this consensus. A "literature group" (four surgeons); "steering group" (14 surgeons and scientists); "rating group" (19 surgeons) and finally "peer review group" (51 representatives of the ESSKA-affiliated national societies from 27 countries). The steering group prepared eighteen question-answer sets. The quality of the answers received grades of recommendation ranging from A (high-level scientific support), to B (scientific presumption), C (low level scientific support) or D (expert opinion). These question-answer sets were then evaluated by the rating group. All answers were scored from 1 to 9. The comments of the rating group were incorporated by the steering group and the consensus was submitted to the rating group a second time. Once a general consensus was reached between the steering and rating groups, the question-answer sets were submitted to the peer review group. A final combined meeting of all the members of the consensus was held to ratify the document.

Results: The literature review for the diagnosis and preoperative planning of ACL revision revealed a rather low scientific quality. None of the 18 questions was graded A and six received a grade B. The mean rating of all the questions by the rating group was 8.4 ± 0.3. The questions and recommendations are listed below.

Conclusion: ACL revision surgery is a widely debated subject with many different opinions and techniques. The literature reveals a poor level of standardisation. Therefore, this international consensus project is of great importance.

Level of evidence: II.

Keywords: Anterior cruciate ligament; Consensus; Failure; Revision; Surgery.