Controversies in ACL Revision Surgery: Italian Expert Group Consensus and State of the Art

Overview

Journal J Orthop Traumatol

Specialties Emergency Medicine
Orthopedics

Date 2022 Jul 15

PMID 35840726

Authors

Fabrizio Matassi

Niccolo Giabbani

Enrico Arnaldi

Alessandro Tripodo

Giovanni Bonaspetti

Corrado Bait

Mario Ronga

Paolo Di Benedetto

Stefano Zaffagnini

Eugenio Jannelli

Alfredo Schiavone Panni

Massimo Berruto

Affiliations

Soon will be listed here.

Abstract

Background: Revision ACL reconstruction is a complex topic with many controversies and not-easy-to-make decisions. The authors' aim is to provide some feasible advice that can be applied in daily clinical practice with the goal of facilitating the decision-making process and improving the outcomes of patients subjected to revision ACL reconstruction.

Methods: A national survey with seven questions about the most controversial topics in revision ACL reconstruction was emailed to members of two societies: SIOT and SIAGASCOT. The participants' answers were collected, the most recent literature was analyzed, and a consensus was created by the authors, according to their long-term surgical experience.

Conclusions: The decision-making process in revision ACL reconstruction starts with a standardized imaging protocol (weight-bearing radiographs, CT scan, and MRI). One-stage surgery is indicated in almost all cases (exceptions are severe tunnel enlargement and infection), while the choice of graft depends on the previously used graft and the dimensions of the tunnels, with better clinical outcomes obtained for autografts. Additional procedures such as lateral extra-articular tenodesis in high-grade pivot-shift knees, biplanar HTO in the case of severe coronal malalignment, and meniscal suture improve the clinical outcome and should be considered case by case.

Level Of Evidence: V (Expert opinion).

Citing Articles

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One-stage revision anterior cruciate ligament reconstruction: Preoperative evaluation, planning and surgical techniques. A review of current concepts.

Giannakis P, Zhuang S, Rosenstadt J, Marx R J Exp Orthop. 2025; 12(1):e70111.

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Comparative Evaluation of Treatment Outcomes of Revision Anterior Cruciate Ligament Reconstruction Using Allograft and Semitendinosus Autograft.

Kentel M, Kentel M, Korolczuk K, Witkowski J J Clin Med. 2025; 14(1.

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Modifiable and non-modifiable risk factors affecting surgical failure after revision ACL reconstruction: a cohort study.

Moon H, Jung M, Choi C, Chung K, Jung S, Byun J Knee Surg Relat Res. 2024; 36(1):37.

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Posterior Lateral Meniscal Root Repair Through Lateral Tunnel and Anterior Cruciate Ligament Revision: How to Avoid Tunnel Overlapping.

Matassi F, Taha Z, Civinini A, Di Muro A, Corti J, Civinini R Arthrosc Tech. 2024; 13(10):103089.

PMID: 39479043 PMC: 11519867. DOI: 10.1016/j.eats.2024.103089.

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