The REVision Using Imaging to Guide Staging and Evaluation (REVISE) in ACL Reconstruction Classification

Darren de SA; Raphael J. Crum; Stephen Rabuck; Olufemi Ayeni; Asheesh Bedi; Michael Baraga; Alan Getgood; Scott Kaar; Eric Kropf; Craig Mauro; Devin Peterson; Dharmesh Vyas; Volker Musahl; Bryson P. Lesniak

doi:10.1055/s-0039-1697902

The Journal of Knee Surgery, Inhaltsverzeichnis

J Knee Surg 2021; 34(05): 509-519
DOI: 10.1055/s-0039-1697902

Original Article

The REVision Using Imaging to Guide Staging and Evaluation (REVISE) in ACL Reconstruction Classification

Autoren

Darren de SA

¹Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
Raphael J. Crum

²School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
Stephen Rabuck

¹Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
Olufemi Ayeni

³Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
Asheesh Bedi

⁴Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
Michael Baraga

⁵Department of Orthopaedic Surgery, University of Miami, Miami, Florida
Alan Getgood

⁶Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
Scott Kaar

⁷Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri
Eric Kropf

⁸Temple Orthopaedics at the Navy Yard, Vincera Institute, Philadelphia, Pennsylvania
Craig Mauro

⁹Burke and Bradley Orthopaedics, University of Pittsburgh, Pittsburgh, Pennsylvania
Devin Peterson

³Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
Dharmesh Vyas

¹Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
Volker Musahl

¹Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
Bryson P. Lesniak

¹Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania

Abstract

Revision anterior cruciate ligament (ACL) procedures are increasing in incidence and possess markedly inferior clinical outcomes (76% satisfaction) and return-to-sports (57%) rates than their primary counterparts. Given their complexity, a universal language is required to identify and communicate the technical challenges faced with revision procedures and guide treatment strategies. The proposed REVision using Imaging to guide Staging and Evaluation (REVISE) ACL (anterior cruciate ligament) Classification can serve as a foundation for this universal language that is feasible and practical with acceptable inter-rater agreement. A focus group of sports medicine fellowship-trained orthopaedic surgeons was assembled to develop a classification to assess femoral/tibial tunnel “usability” (placement, widening, overlap) and guide the revision reconstruction strategy (one-stage vs. two-stage) post–failed ACL reconstruction. Twelve board-certified sports medicine orthopaedic surgeons independently applied the classification to the de-identified computed tomographic (CT) scan data of 10 patients, randomly selected, who failed ACL reconstruction. An interclass correlation coefficient (ICC) was calculated (with 95% confidence intervals) to assess agreement among reviewers concerning the three major classifications of the proposed system. Across surgeons, and on an individual patient basis, there was high internal validity and observed agreement on treatment strategy (one-stage vs. two-stage revision). Reliability testing of the classification using CT scan data demonstrated an ICC (95% confidence interval) of 0.92 (0.80–0.98) suggesting “substantial” agreement between the surgeons across all patients for all elements of the classification. The proposed REVISE ACL Classification, which employs CT scan analysis to both identify technical issues and guide revision ACL treatment strategy (one- or two-stage), constitutes a feasible and practical system with high internal validity, high observed agreement, and substantial inter-rater agreement. Adoption of this classification, both clinically and in research, will help provide a universal language for orthopaedic surgeons to discuss these complex clinical presentations and help standardize an approach to diagnosis and treatment to improve patient outcomes. The Level of Evidence for this study is 3.

Keywords

ACL - ACL Revision - REVISE - ACL reconstruction

Volltext

Referenzen

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