APKASS 2024共识声明：前交叉韧带重建（第二部分）——成人前交叉韧带翻修的管理
简介
APKASS 2024专家共识基于8个国家23名专家的调查，为成人ACL翻修术提供了诊疗与康复建议。共识指出骨道位置不良是ACL失败的首要原因，CT是评估骨道的首选；单期翻修优先，骨-髌腱-骨自体移植物为首选，高龄与骨性关节炎被视为相对禁忌。该共识强调个体化、循证策略，但证据等级为V级（专家意见），供临床决策参考。
英文摘要
BACKGROUND: Revision anterior cruciate ligament reconstruction (ACLR) is a complex procedure with varying diagnostic, surgical, and rehabilitation approaches. This study aimed to develop a consensus among surgeons from APKASS on key aspects of revision ACLR to improve clinical outcomes. METHODS: A total of 23 expert surgeons from eight member countries participated in the survey. Topics included diagnostics, surgical indications, techniques, graft selection, rehabilitation protocols, and return-to-play (RTP) considerations for revision ACLR. Responses were analyzed in comparison with the current literature to identify areas of agreement and divergence. RESULTS: A consensus was reached on the importance of clinical and imaging criteria, including the pivot shift test, KT-2000 measurements, and MRI for identifying ACL failure. CT was preferred for evaluating tunnel placement. Poor tunnel placement was identified as the leading cause of ACL failure. One-stage revision surgeries were favoured unless significant tunnel enlargement required a two-stage approach. Bone-patellar tendon-bone (BTB) autografts were the preferred graft choice, while quadriceps tendon (QT) autografts emerged as a viable alternative. Revision ACLR was deemed critical for active patients engaged in high-impact sports, while older age and established osteoarthritis were considered relative contraindications. Additional procedures, such as lateral extra-articular tenodesis (LET), were selectively indicated based on individual patient factors. Conservative, patient-specific rehabilitation protocols were recommended, with an emphasis on addressing psychological factors. RTP rates varied widely, highlighting the importance of tailored recovery plans to optimize outcomes. CONCLUSION: This consensus emphasizes the importance of individualized and evidence-based approaches in revision ACLR, from diagnostics and surgical techniques to rehabilitation and RTP. Standardized criteria and further research are essential to refine strategies and improve outcomes in this patient population. LEVEL OF EVIDENCE: V (Expert opinion).