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Abstract：
OBJECTIVE: The aim of the ESSKA 2022 consensus Part III was to develop patient-focused, contemporary, evidence-based, guidelines on the indications for revision anterior cruciate ligament surgery (ACLRev).
METHODS: 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-step voting process, the panel established a consensus as to the appropriateness of ACLRev for each scenario based on a nine-point Likert scale (in which a score in the range 1-3 was considered \'inappropriate\', 4-6 \'uncertain\', and 7-9 \'appropriate\').
RESULTS: The criteria used to define the scenarios were: age (18-35 years vs 36-50 years vs 51-60 years), sports activity and expectation (Tegner 0-3 vs 4-6 vs 7-10), instability symptoms (yes vs no), meniscus status (functional vs repairable vs non-functional meniscus), and osteoarthritis (OA) (Kellgren-Lawrence [KL] grade 0-I-II 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 ≤ 50 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 (51-60 years), low sporting expectation, non-functional meniscus, and knee OA (KL III).
CONCLUSIONS: 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.
METHODS: II.
METHODS: 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-step voting process, the panel established a consensus as to the appropriateness of ACLRev for each scenario based on a nine-point Likert scale (in which a score in the range 1-3 was considered \'inappropriate\', 4-6 \'uncertain\', and 7-9 \'appropriate\').
RESULTS: The criteria used to define the scenarios were: age (18-35 years vs 36-50 years vs 51-60 years), sports activity and expectation (Tegner 0-3 vs 4-6 vs 7-10), instability symptoms (yes vs no), meniscus status (functional vs repairable vs non-functional meniscus), and osteoarthritis (OA) (Kellgren-Lawrence [KL] grade 0-I-II 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 ≤ 50 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 (51-60 years), low sporting expectation, non-functional meniscus, and knee OA (KL III).
CONCLUSIONS: 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.
METHODS: II.
摘要：
目标：ESSKA2022共识第三部分的目标是开发以患者为中心的，当代,以证据为基础,关于修正前交叉韧带手术（ACLRev）适应症的指南。
方法：RAND/UCLA适当性方法（RAM）用于根据当前的科学证据和专家意见，就不同临床情况下手术治疗与保守治疗的适当性提供建议。核心小组与主持人一起定义了临床场景，然后指导由17名投票专家组成的小组完成RAM任务。通过两步投票过程，小组基于9分的李克特量表(其中1-3分范围内的分数被认为是“不合适的”,4-6\'不确定\'，和7-9\'适当\')。
结果：用于定义方案的标准是：年龄（18-35岁vs36-50岁vs51-60岁），体育活动和期望（Tegner0-3vs4-6vs7-10），不稳定症状（是vs否），半月板状态（功能vs可修复vs非功能半月板），和骨关节炎（OA）（Kellgren-Lawrence[KL]0-I-II级与III级）。基于这些变量，我们制定了一组108种临床方案.ACLRev在58%被认为是合适的，12%的患者不合适(意味着需要保守治疗)，不确定在30%。专家认为ACLRev适合有不稳定症状的患者，年龄≤50岁，无论体育活动水平如何，弯月面状态，OA等级。结果在没有不稳定症状的患者中更具争议性，而较高的不适当性与年龄较大（51-60岁）的情景有关，低运动期望，非功能性半月板，和膝关节OA（KLIII）。
结论：本专家共识根据定义的标准建立了关于ACLRev适当性的指南，为临床实践确定治疗指征提供了有用的参考。
方法：II.
方法：RAND/UCLA适当性方法（RAM）用于根据当前的科学证据和专家意见，就不同临床情况下手术治疗与保守治疗的适当性提供建议。核心小组与主持人一起定义了临床场景，然后指导由17名投票专家组成的小组完成RAM任务。通过两步投票过程，小组基于9分的李克特量表(其中1-3分范围内的分数被认为是“不合适的”,4-6\'不确定\'，和7-9\'适当\')。
结果：用于定义方案的标准是：年龄（18-35岁vs36-50岁vs51-60岁），体育活动和期望（Tegner0-3vs4-6vs7-10），不稳定症状（是vs否），半月板状态（功能vs可修复vs非功能半月板），和骨关节炎（OA）（Kellgren-Lawrence[KL]0-I-II级与III级）。基于这些变量，我们制定了一组108种临床方案.ACLRev在58%被认为是合适的，12%的患者不合适(意味着需要保守治疗)，不确定在30%。专家认为ACLRev适合有不稳定症状的患者，年龄≤50岁，无论体育活动水平如何，弯月面状态，OA等级。结果在没有不稳定症状的患者中更具争议性，而较高的不适当性与年龄较大（51-60岁）的情景有关，低运动期望，非功能性半月板，和膝关节OA（KLIII）。
结论：本专家共识根据定义的标准建立了关于ACLRev适当性的指南，为临床实践确定治疗指征提供了有用的参考。
方法：II.
