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Condello V, Beaufilis P, Becker R, Ahmad SS, Bonomo M, Dejour D, Eriksson K, Filardo G, Feucht MJ, Grassi A, Wilson A, Menetrey J, Pujol N, Rathcke M, Seil R, Strauss MJ, Tischer T. Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus: part II-surgical strategy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4652-4661. [PMID: 37700168 PMCID: PMC10598082 DOI: 10.1007/s00167-023-07550-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/10/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The aim of this ESSKA consensus is to give recommendations based on scientific evidence and expert opinion to improve the diagnosis, preoperative planning, indication and surgical strategy in Anterior Cruciate Ligament revision. METHODS Part 2, presented herein, followed exactly the same methodology as Part 1: the so-called ESSKA formal consensus derived from the Delphi method. Eighteen questions were ultimately asked. The quality of the answers received the following grades of recommendation: Grade A (high level scientific support), Grade B (scientific presumption), Grade C (low level scientific support) or Grade D (expert opinion). All answers were scored from 1 to 9 by the raters. Once a general consensus had been 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 then held to ratify the document. RESULTS The review of the literature revealed a rather low scientific quality of studies examining the surgical strategy in cases of ACL reconstruction failure. Of the 18 questions, only 1 received a Grade A rating; 5, a Grade B rating; and 9, grades of C or D. The three remaining complex questions received further evaluations for each portion of the question and were looked at in more detail for the following grades: B and D; A, C and D; or A, B, C and D. The mean rating of all questions by the rating group was 8.0 + - 1.1. The questions and recommendations are listed in the article. CONCLUSION ACL revision surgery, especially the surgical strategy, is a widely debated subject with many different opinions and techniques. The literature reveals a poor level of standardization. Therefore, this international European consensus project is of great importance and clinical relevance for guiding the management of ACL revision in adults. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Vincenzo Condello
- Joint Preservation and Reconstructive Surgery and Sports Medicine Unit, Humanitas Castelli Clinic, Bergamo, Italy.
- Department of Orthopaedic Surgery, Clinica San Francesco - GHC Group, Verona, Italy.
| | | | - Roland Becker
- Centre of Orthopaedic and Traumatology, University of Brandenburg an der Havel, Brandenburg, Germany
| | - Sufian S Ahmad
- Department of Orthopaedic Surgery of the Medical School of Hannover MHH, Annastift Hospital, Hannover, Germany
| | - Marco Bonomo
- Dipartimento di Ortopedia e Traumatologia, IRCCS Ospedale Sacro Cuore don Calabria, Negrar, VR, Italy
| | - David Dejour
- Lyon Ortho Clinic, Clinique de la sauvegarde Ramsay Santé, 29 avenue des sources, Lyon, France
| | - Karl Eriksson
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Matthias J Feucht
- Department of Orthopaedic Surgery Paulinenhilfe, Diakonie Klinikum, Stuttgart, Germany
- Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Adrian Wilson
- Orthopaedic Specialist Group, Harley Street Specialist Hospital, Queen Anne St, London, UK
| | - Jacques Menetrey
- Center of Sports Medicine and Exercise, Hirslanden Clinique La Colline, Geneva, Switzerland
- Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland
| | - Nicolas Pujol
- Centre Hospitalier de Versailles, Department of Orthopaedic and Trauma Surgery, Le Chesnay, France
| | - Martin Rathcke
- Department of Orthopaedics and Sportstraumatology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier - Clinique d'Eich and Luxembourg Institute of Health, Luxembourg, Luxembourg
| | | | - Thomas Tischer
- Department of Orthopaedic and Trauma Surgery, Waldkrankenhaus Erlangen, Erlangen, Germany
- Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany
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Tischer T, Beaufilis P, Becker R, Ahmad SS, Bonomo M, Dejour D, Eriksson K, Filardo G, Feucht MJ, Grassi A, Wilson A, Menetrey J, Pujol N, Rathcke M, Seil R, Strauss MJ, Condello V. Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus part I-diagnostics and preoperative planning. Knee Surg Sports Traumatol Arthrosc 2023; 31:4642-4651. [PMID: 36322180 DOI: 10.1007/s00167-022-07214-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
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.
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Affiliation(s)
- Thomas Tischer
- Klinik für Orthopädie und Unfallchirurgie, Malteser Waldkrankenhaus St. Marien, Rathsberger Straße 57, 91054, Erlangen, Germany.
- Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany.
| | | | - Roland Becker
- Centre of Orthopaedic and Traumatology, University of Brandenburg an Der Havel, Brandenburg, Germany
| | - Sufian S Ahmad
- Department of Orthopaedic Surgery of the Medical School of Hannover MHH, Annastift Hospital, Hannover, Germany
| | - Marco Bonomo
- Dipartimento di Ortopedia e Traumatologia, IRCCS Ospedale Sacro Cuore don Calabria, Negrar, VR, Italy
| | - David Dejour
- Lyon Ortho Clinic, Clinique de la sauvegarde Ramsay Santé, 29 avenue des sources, Lyon, France
| | - Karl Eriksson
- Department of Orthopaedics, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Matthias J Feucht
- Department of Orthopaedic Surgery Paulinenhilfe, Diakonie Klinikum, Stuttgart, Germany
- Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Adrian Wilson
- Orthopaedic Specialist Group, Harley Street Specialist Hospital, Queen Anne St, London, UK
| | - Jacques Menetrey
- Center of Sports Medicine and Exercise, Hirslanden Clinique La Colline, Geneva, Switzerland
- Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland
| | - Nicolas Pujol
- Department of Orthopaedic and Trauma Surgery, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France
| | - Martin Rathcke
- Department of Orthopaedics and Sports traumatology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier-Clinique d'Eich and Luxembourg Institute of Health, Luxembourg, Luxembourg
| | | | - Vincenzo Condello
- Joint Preservation and Reconstructive Surgery and Sports Medicine Unit, Humanitas Castelli Clinic, Bergamo, Italy
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