{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:14:51Z","timestamp":1786979691330,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T00:00:00Z","timestamp":1683072000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T00:00:00Z","timestamp":1683072000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T00:00:00Z","timestamp":1683072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,11]]},"abstract":"Abstract<\/jats:title>\n \n Purpose<\/jats:title>\n The aim of the ESSKA 2022 consensus Part III was to develop patient\u2010focused, contemporary, evidence\u2010based, guidelines on the indications for revision anterior cruciate ligament surgery (ACLRev).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u2010step voting process, the panel established a consensus as to the appropriateness of ACLRev for each scenario based on a nine\u2010point Likert scale (in which a score in the range 1\u20133 was considered \u2018inappropriate\u2019, 4\u20136 \u2018uncertain\u2019, and 7\u20139 \u2018appropriate\u2019).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The criteria used to define the scenarios were: age (18\u201335 years vs 36\u201350 years vs 51\u201360 years), sports activity and expectation (Tegner 0\u20133 vs 4\u20136 vs 7\u201310), instability symptoms (yes vs no), meniscus status (functional vs repairable vs non\u2010functional meniscus), and osteoarthritis (OA) (Kellgren\u2013Lawrence [KL] grade 0\u2013I\u2013II 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\u2009\u2264\u200950 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\u201360 years), low sporting expectation, non\u2010functional meniscus, and knee OA (KL III).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Level of evidence<\/jats:title>\n II.<\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s00167-023-07401-3","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T06:03:05Z","timestamp":1683093785000},"page":"4662-4672","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Management of anterior cruciate ligament revision in adults: the 2022 ESSKA consensus part III\u2014indications for different clinical scenarios using the RAND\/UCLA appropriateness method"],"prefix":"10.1002","volume":"31","author":[{"given":"Thomas","family":"Tischer","sequence":"first","affiliation":[{"name":" Department of Orthopaedic and Trauma Surgery Waldkrankenhaus Erlangen Germany"},{"name":" Department of Orthopaedic Surgery University Medicine Rostock Rostock Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6352-9671","authenticated-orcid":false,"given":"Luca","family":"Andriolo","sequence":"additional","affiliation":[{"name":" Clinica Ortopedica e Traumatologica 2 IRCCS Istituto Ortopedico Rizzoli Via Pupilli 1 40136 Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Beaufils","sequence":"additional","affiliation":[{"name":" ESSKA Consensus Projects Versailles France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sufian S.","family":"Ahmad","sequence":"additional","affiliation":[{"name":" Department of Orthopaedic Surgery Medical School of Hannover MHH, Annastift Hospital Hannover Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corrado","family":"Bait","sequence":"additional","affiliation":[{"name":" Joint Preservation Surgery and Sport Medicine Unit Villa Aprica Clinical Institute Como Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bonomo","sequence":"additional","affiliation":[{"name":" Dipartimento di Ortopedia e Traumatologia IRCCS Ospedale Sacro Cuore don Calabria Negrar VR Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Cavaignac","sequence":"additional","affiliation":[{"name":" Musculoskeletal Institute H\u00f4pital Pierre Paul Riquet, CHU Toulouse Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Cristiani","sequence":"additional","affiliation":[{"name":" Capio Artro Clinic FIFA Medical Centre of Excellence Valhallav\u00e4gen 91 11486 Stockholm Sweden"},{"name":" Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center Karolinska Institutet Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias J.","family":"Feucht","sequence":"additional","affiliation":[{"name":" Department of Orthopaedic Surgery Paulinenhilfe Diakonie Klinikum Stuttgart Germany"},{"name":" Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine Albert\u2010Ludwigs\u2010University of Freiburg Freiburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markas","family":"Fiodorovas","sequence":"additional","affiliation":[{"name":" Northway Medical Center Klaipeda Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Grassi","sequence":"additional","affiliation":[{"name":" Clinica Ortopedica e Traumatologica 2 IRCCS Istituto Ortopedico Rizzoli Via Pupilli 1 40136 Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gijs","family":"Helmerhorst","sequence":"additional","affiliation":[{"name":" Department of Orthopaedic Surgery Amsterdam University Medical Centre (AUMC) and Flevoziekenhuis Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hoser","sequence":"additional","affiliation":[{"name":" Praxisgemeinschaft Gelenkpunkt Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Karahan","sequence":"additional","affiliation":[{"name":" MAA Ac\u0131badem University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Komnos","sequence":"additional","affiliation":[{"name":" Orthopaedic Department University Hospital of Larisa Larisa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koen Carl","family":"Lagae","sequence":"additional","affiliation":[{"name":" Knee and Sports Surgery, Knee Department Monica Hospitals Antwerp Belgium"},{"name":" Hopital Delta Brussels Belgium"},{"name":" Physioclinic Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Madonna","sequence":"additional","affiliation":[{"name":" Joint Preservation and Reconstructive Surgery and Sports Medicine Unit Humanitas Castelli Clinic Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Monaco","sequence":"additional","affiliation":[{"name":" Orthopaedic Unit University of Rome La Sapienza, Sant\u2019Andrea Hospital Rome 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December 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 March 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 May 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no conflicts of interest relevant to this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The consensus project was endorsed by the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"This article does not contain any studies with human participants or animals performed by any of the authors.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}