Knee Surgery,Sports Traumatology,Arthroscopyhttp5/doi.org/10.1007/s00167-023-07401-3KNEEManagement of anterior cruciate ligament revision in adults:the 2022ESSKA consensus part lll-indications for different clinical scenariosusing the RAND/UCLA appropriateness methodThomas Tischer12.Luca Andriolo3.Philippe Beaufils.Sufian S.Ahmad5.Corrado Bait5.Marco Bonomo?.Etienne Cavaignac.Riccardo Cristiani10.Matthias J.Feucht11,12.Markas Fiodorovas13.Alberto Grassi3.Gijs Helmerhorst4.Christian Hoser5.Mustafa Karahan16.George Komnos7.Koen Carl Lagae2.Vincenzo Madonna21.Edoardo Monaco22.Juan Carlos Monllau23.Matthieu Ollivier24.Mikko Ovaska25.Wolf Petersen26.Tomasz Piontek27.James Robinson28.Kristian Samuelsson2930.Sven Scheffler31.Bertrand Sonnery-Cottet32.Giuseppe Filardo33,34,35.Vincenzo Condello21Received:6 December 2022/Accepted:20 March 2023eThe Author(s)2023AbstractPurpose 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 appropriate-ness of surgical treatment versus conservative treatment in different clinical scenarios based on current scientific evidencein conjunction with expert opinion.A core panel defined the clinical scenarios with a moderator and then guided a panelof 17 voting experts through the RAM tasks.Through a two-step voting process,the panel established a consensus as tothe appropriateness of ACLRev for each scenario based on a nine-point Likert scale(in which a score in the range 1-3 wasconsidered '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 activityand expectation (Tegner 0-3 vs 4-6 vs 7-10),instability symptoms(yes vs no),meniscus status(functional vs repairablevs non-functional meniscus),and osteoarthritis(OA)(Kellgren-Lawrence [KL]grade 0-I-II vs grade III).Based on thesevariables,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 patientswith instability symptoms,aged <50 years,regardless of sports activity level,meniscus status,and OA grade.Results weremuch more controversial in patients without instability symptoms,while higher inappropriateness was related to scenarioswith older age (51-60 years),low sporting expectation,non-functional meniscus,and knee OA (KL IID.Conclusion This expert consensus establishes guidelines as to the appropriateness of ACLRev based on defined criteria andprovides a useful reference for clinical practice in determining treatment indications.Level of evidenceⅡ.Keywords Anterior cruciate ligament.Revision.Consensus.Knee.GuidelinesIntroductionmostly young,active patients [2],in which ACL reconstruc-
