Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus part III-indications for different clinical scenarios using the RAND/UCLA appropriateness method.

Autor: Tischer T; Department of Orthopaedic and Trauma Surgery, Waldkrankenhaus, Erlangen, Germany.; Department of Orthopaedic Surgery, University Medicine Rostock, Rostock, Germany., Andriolo L; Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy. lucas.andriolo@gmail.com., Beaufils P; ESSKA Consensus Projects, Versailles, France., Ahmad SS; Department of Orthopaedic Surgery, Medical School of Hannover MHH, Annastift Hospital, Hannover, Germany., Bait C; Joint Preservation Surgery and Sport Medicine Unit, Villa Aprica Clinical Institute, Como, Italy., Bonomo M; Dipartimento di Ortopedia e Traumatologia, IRCCS Ospedale Sacro Cuore don Calabria, Negrar, VR, Italy., Cavaignac E; Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France., Cristiani R; Capio Artro Clinic, FIFA Medical Centre of Excellence, Valhallavägen 91, 11486, Stockholm, Sweden.; Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden., Feucht MJ; 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., Fiodorovas M; Northway Medical Center, Klaipeda, Lithuania., Grassi A; Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy., Helmerhorst G; Department of Orthopaedic Surgery, Amsterdam University Medical Centre (AUMC) and Flevoziekenhuis, Amsterdam, The Netherlands., Hoser C; Praxisgemeinschaft Gelenkpunkt, Innsbruck, Austria., Karahan M; MAA Acıbadem University, Istanbul, Turkey., Komnos G; Orthopaedic Department, University Hospital of Larisa, Larisa, Greece., Lagae KC; Knee and Sports Surgery, Knee Department, Monica Hospitals, Antwerp, Belgium.; Hopital Delta, Brussels, Belgium.; Physioclinic, Milan, Italy., Madonna V; Joint Preservation and Reconstructive Surgery and Sports Medicine Unit, Humanitas Castelli Clinic, Bergamo, Italy., Monaco E; Orthopaedic Unit, University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy., Monllau JC; Department of Orthopaedics and Traumatology, Parc de Salut Mar, ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain., Ollivier M; Institut for Movement and Locomotion, Hôpital Sainte Marguerite, UMR 7287, Aix-Marseille Université et CNRS, Marseille, France., Ovaska M; Lower Extremity Unit, Pihlajalinna Pikkuhuopalahti, Helsinki, Finland., Petersen W; Martin Luther Hospital, Berlin, Germany., Piontek T; Rehasport, Spine Disorders and Pediatric Orthopaedic Department, University of Medical Sciences, Poznań, Poland., Robinson J; Knee Specialists, Bristol, UK., Samuelsson K; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden., Scheffler S; Sporthopaedicum Berlin, Berlin, Germany., Sonnery-Cottet B; Centre Orthopédique Santy, FIFA medical centre of Excellence, Hôpital Privé Jean Mermoz, Ramsay, Lyon, France., Filardo G; Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.; Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland., Condello V; Joint Preservation and Reconstructive Surgery and Sports Medicine Unit, Humanitas Castelli Clinic, Bergamo, Italy.
Jazyk: angličtina
Zdroj: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc] 2023 Nov; Vol. 31 (11), pp. 4662-4672. Date of Electronic Publication: 2023 May 03.
DOI: 10.1007/s00167-023-07401-3
Abstrakt: 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.
(© 2023. The Author(s).)
Databáze: MEDLINE
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