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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

Darren de SA
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Raphael J. Crum 
2   School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Stephen Rabuck
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Olufemi Ayeni 
3   Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
,
Asheesh Bedi
4   Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
,
Michael Baraga
5   Department of Orthopaedic Surgery, University of Miami, Miami, Florida
,
Alan Getgood
6   Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
,
Scott Kaar
7   Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri
,
Eric Kropf
8   Temple Orthopaedics at the Navy Yard, Vincera Institute, Philadelphia, Pennsylvania
,
Craig Mauro
9   Burke and Bradley Orthopaedics, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Devin Peterson
3   Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
,
Dharmesh Vyas
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Volker Musahl
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Bryson P. Lesniak
1   Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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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


Publication History

Received: 12 January 2019

Accepted: 12 August 2019

Article published online:
30 September 2019

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