Controversies in ACL revision surgery: Italian expert group consensus and state of the art.
ACLR failure
Anterior cruciate ligament reconstruction
Anterior cruciate ligament revision
Consensus
Italian expert group
Revision
Survey
Journal
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
ISSN: 1590-9999
Titre abrégé: J Orthop Traumatol
Pays: Italy
ID NLM: 101090931
Informations de publication
Date de publication:
15 Jul 2022
15 Jul 2022
Historique:
received:
30
04
2022
accepted:
19
06
2022
entrez:
15
7
2022
pubmed:
16
7
2022
medline:
20
7
2022
Statut:
epublish
Résumé
Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors' aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction. A national survey with seven questions about the most controversial topics in revision ACL reconstruction was emailed to members of two societies: SIOT and SIAGASCOT. The participants' answers were collected, the most recent literature was analyzed, and a consensus was created by the authors, according to their long-term surgical experience. The decision-making process in revision ACL reconstruction starts with a standardized imaging protocol (weight-bearing radiographs, CT scan, and MRI). One-stage surgery is indicated in almost all cases (exceptions are severe tunnel enlargement and infection), while the choice of graft depends on the previously used graft and the dimensions of the tunnels, with better clinical outcomes obtained for autografts. Additional procedures such as lateral extra-articular tenodesis in high-grade pivot-shift knees, biplanar HTO in the case of severe coronal malalignment, and meniscal suture improve the clinical outcome and should be considered case by case. V (Expert opinion).
Sections du résumé
BACKGROUND
BACKGROUND
Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors' aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction.
METHODS
METHODS
A national survey with seven questions about the most controversial topics in revision ACL reconstruction was emailed to members of two societies: SIOT and SIAGASCOT. The participants' answers were collected, the most recent literature was analyzed, and a consensus was created by the authors, according to their long-term surgical experience.
CONCLUSIONS
CONCLUSIONS
The decision-making process in revision ACL reconstruction starts with a standardized imaging protocol (weight-bearing radiographs, CT scan, and MRI). One-stage surgery is indicated in almost all cases (exceptions are severe tunnel enlargement and infection), while the choice of graft depends on the previously used graft and the dimensions of the tunnels, with better clinical outcomes obtained for autografts. Additional procedures such as lateral extra-articular tenodesis in high-grade pivot-shift knees, biplanar HTO in the case of severe coronal malalignment, and meniscal suture improve the clinical outcome and should be considered case by case.
LEVEL OF EVIDENCE
METHODS
V (Expert opinion).
Identifiants
pubmed: 35840726
doi: 10.1186/s10195-022-00652-9
pii: 10.1186/s10195-022-00652-9
pmc: PMC9287504
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
32Informations de copyright
© 2022. The Author(s).
Références
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