Mingde Cao, Yuichi Hoshino, Gilbert Moatshe, Joon Ho Wang, Pakapon Issaragrisil, Stefan Mogos, Nadhaporn Saengpetch, Chanakarn Phornphutkul, Jin Goo Kim, Ryosuke Kuroda, Nattha Kulkamthorn, Hideyuki Koga, Shuhei Otsuki, Ryuichiro Akagi, Sang-Hak Lee, Karl Eriksson, Kyoung Ho Yoon, Bancha Chernchujit, Ekavit Keyurapan, Vasileios Raoulis, Rainer Siebold, Jonathan Patrick Ng, Patrick Shu-Hang Yung, Michael Tim-Yun Ong
This consensus emphasizes the importance of individualized and evidence-based approaches in revision ACLR, from diagnostics and surgical techniques to rehabilitation and RTP. Standardized criteria and further research are essential to refine strategies and improve outcomes in this patient population.
BACKGROUND: Revision anterior cruciate ligament reconstruction (ACLR) is a complex procedure with varying diagnostic, surgical, and rehabilitation approaches. This study aimed to develop a consensus among surgeons from APKASS on key aspects of revision ACLR to improve clinical outcomes.
METHODS: A total of 23 expert surgeons from eight member countries participated in the survey. Topics included diagnostics, surgical indications, techniques, graft selection, rehabilitation protocols, and return-to-play (RTP) considerations for revision ACLR. Responses were analyzed in comparison with the current literature to identify areas of agreement and divergence.
RESULTS: A consensus was reached on the importance of clinical and imaging criteria, including the pivot shift test, KT-2000 measurements, and MRI for identifying ACL failure. CT was preferred for evaluating tunnel placement. Poor tunnel placement was identified as the leading cause of ACL failure. One-stage revision surgeries were favoured unless significant tunnel enlargement required a two-stage approach. Bone-patellar tendon-bone (BTB) autografts were the preferred graft choice, while quadriceps tendon (QT) autografts emerged as a viable alternative. Revision ACLR was deemed critical for active patients engaged in high-impact sports, while older age and established osteoarthritis were considered relative contraindications. Additional procedures, such as lateral extra-articular tenodesis (LET), were selectively indicated based on individual patient factors. Conservative, patient-specific rehabilitation protocols were recommended, with an emphasis on addressing psychological factors. RTP rates varied widely, highlighting the importance of tailored recovery plans to optimize outcomes.
CONCLUSION: This consensus emphasizes the importance of individualized and evidence-based approaches in revision ACLR, from diagnostics and surgical techniques to rehabilitation and RTP. Standardized criteria and further research are essential to refine strategies and improve outcomes in this patient population.
LEVEL OF EVIDENCE: V (Expert opinion).