Time to focus on ACL revision: ESSKA 2022 consensus

Excerpt

Anterior cruciate ligament (ACL) reconstruction is generally regarded as a safe and effective procedure with high return to sport and low rerupture rates (4.9% rerupture rate after a mean FU time of 8.1 years according to the Norwegian Knee Ligament Registry) [10]. However, subgroups such as adolescents or young women are at higher risk of failure. For instance, in adolescents, the failure rate is twice as high as that in young adults [13]. Nonetheless, due to the increasing number of ACL reconstructions performed annually, the number of ACL revisions (ACL-Rs) is rising automatically. ACL-R is not merely a second primary ACL reconstruction [5]. Concomitant pathologies, such as cartilage damage, meniscus lesions, bony defects caused by the initial tunnels, or additional peripheral laxity, may predominantly challenge revision surgery [1, 3, 6, 8]. Furthermore, how do we address anatomical deformities such as high posterior tibial slope or varus malalignment? Surgeons should be aware that ACL-R is associated with an increased risk of 30‐day hospital readmission (0.6% vs. 1.9%), reoperation (0.5% vs. 1.9%), and surgical complications (0.5% vs. 1.9%) compared with primary ACL reconstruction [11]. A review of numerous studies demonstrated inferior outcomes after ACL-R surgery compared to primary reconstruction at 5 years of follow-up based on both objective and patient-reported outcome parameters [15]. Joint effusion, degree of anteroposterior instability, lack of quadriceps strength and degree of patellofemoral osteoarthritis significantly deteriorate clinical outcome after ACL revision [2]. …