{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:58:02Z","timestamp":1792634282180,"version":"4.5.0"},"reference-count":34,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T00:00:00Z","timestamp":1665532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T00:00:00Z","timestamp":1665532800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T00:00:00Z","timestamp":1665532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012352","name":"Universit\u00e0 degli Studi di Milano","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012352","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100012352","name":"Universit\u00e0 degli Studi di Milano","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012352","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Given the paucity of literature on the re\u2010revision of ACL, the current study was undertaken. The purpose of this systematic review was to synthesise and qualitatively assess the currently available evidence in the literature regarding the re\u2010revision of ACL reconstruction (rrACLR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review was conducted based on the PRISMA guidelines. The following search terms were used in the title, abstract and keywords fields: \u201cACL\u201d or \u201canterior cruciate ligament\u201d AND \u201crevision\u201d or \u201cmultiple\u201d or \u201crepeat\u201d. The outcome data extracted from the studies were the Lysholm score, Subjective IKDC, Marx Score, Tegner, Marx Score, KOOS score, radiological changes and the rate of return to sports. Complications, failures and\/or revision surgery were also analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort consisted of 295 patients [191 (64.7%) men and 104 (35.3%) women] with a mean age of 29.9\u2009\u00b1\u20092.8 years (range 14\u201358 years) from 10 studies. The mean postoperative follow\u2010up (reported in all studies except one) was 66.9\u2009\u00b1\u200944.7\u00a0months (range 13\u2013230.4\u00a0months). Associated injuries were 103 (34.9%) medial meniscus tears, 57 (19.3%) lateral meniscus tears, 14 (4.7%) combined medial plus lateral meniscus tears, 11 (3.7%) meniscal tears (not specified), 252 (85.4%) cartilage lesions, 6 (2.0%) medial collateral ligament injury and 2 (0.7%) lateral collateral ligament injuries. In 47 (15.9%) patients an extra\u2010articular plasty was performed for the anterolateral ligament. In all studies that reported pre\u2010 and post\u2010operative IKDC (subjective and objective) and Lysholm score, there was a significant improvement compared to the pre\u2010operative value (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). At the final follow\u2010up, laxity measured with KT\u20101000 was found to be 2.2\u2009\u00b1\u20090.6\u00a0mm. 31 (10.5%) out of 295 patients returned to their pre\u2010injury activity level. A total of 19 (6.4%) re\u2010ruptures were found, while only 4 (1.4%) complications (all minors) were reported, out of which 2 (0.7%) were superficial infections, 1 (0.3%) cyclops lesion and 1 (0.3%) flexion loss.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Multiple revisions of anterior cruciate ligament reconstruction allow acceptable clinical results and a good degree of knee stability with a low rate of subsequent new re\u2010ruptures but the possibility of regaining pre\u2010injury sports activity is poor; whenever possible, it is preferred to revise the ligament in one stage. This surgery remains a challenge for orthopaedic surgeons and many doubts persist regarding the ideal grafts, additional extra\u2010articular procedures and techniques to use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study registration<\/jats:title><jats:p>PROSPERO<jats:bold>\u2010<\/jats:bold>CRD42022352164 (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/\">https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>).<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-07197-8","type":"journal-article","created":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T13:03:08Z","timestamp":1665579788000},"page":"559-571","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Multiple revision anterior cruciate ligament reconstruction: not the best but still good"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1216-792X","authenticated-orcid":false,"given":"Riccardo","family":"D\u2019Ambrosi","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> IRCCS Orthopedic Institute Galeazzi Via Galeazzi 4 20161 Milan Italy"},{"name":"<!--<label>2<\/label>--> Dipartimento Di Scienze Biomediche Per La Salute Universit\u00e0 Degli Studi Di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Meena","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Gelenkpunkt \u2013 Sports and Joint Surgery FIFA Medical Centre of Excellence Innsbruck Austria"},{"name":"<!--<label>4<\/label>--> Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences Medical Informatics and Technology Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshya","family":"Raj","sequence":"additional","affiliation":[{"name":"<!--<label>5<\/label>--> Central Institute of Orthopaedics Vardhman Mahavir Medical College and Safdarjung Hospital New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Ursino","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> IRCCS Orthopedic Institute Galeazzi Via Galeazzi 4 20161 Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Formica","sequence":"additional","affiliation":[{"name":"<!--<label>6<\/label>--> UOC Clinica Ortopedica IRCCS Policlinico San Martino Genova Italy"},{"name":"<!--<label>7<\/label>--> Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC) Universit\u00e0 degli Studi di Genova Genova Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirco","family":"Herbort","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences Medical Informatics and Technology Innsbruck Austria"},{"name":"<!--<label>8<\/label>--> Orthopadische Chirurgie Munchen Munchen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Fink","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Gelenkpunkt \u2013 Sports and Joint Surgery FIFA Medical Centre of Excellence Innsbruck Austria"},{"name":"<!--<label>4<\/label>--> Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences Medical Informatics and Technology Innsbruck 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