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

Area of Science:

• Orthopaedic Surgery
• Sports Medicine
• Medical Imaging

Background:

• Revision anterior cruciate ligament (ACL) reconstructions have inferior outcomes compared to primary procedures.
• A standardized language is needed to address technical challenges in revision ACL surgery.
• Existing methods lack a consistent approach for evaluating revision complexity and guiding treatment.

Purpose of the Study:

• To develop and validate the REVISE ACL Classification system.
• To assess femoral/tibial tunnel "usability" and guide one-stage versus two-stage revision strategies.
• To establish a universal language for communicating technical challenges in revision ACL reconstruction.

Main Methods:

• A focus group of sports medicine surgeons developed the REVISE ACL Classification.
• The classification assesses tunnel placement, widening, and overlap using CT scans.
• Twelve surgeons applied the classification to 10 patient CT scans, and inter-rater reliability was assessed using the Intraclass Correlation Coefficient (ICC).

Main Results:

• The REVISE ACL Classification demonstrated high internal validity and observed agreement on treatment strategy.
• Inter-rater reliability testing showed an ICC of 0.92 (95% CI: 0.80-0.98), indicating substantial agreement among surgeons.
• The system is feasible and practical for guiding one-stage versus two-stage revision ACL reconstruction.

Conclusions:

• The REVISE ACL Classification provides a feasible and practical system for revision ACL surgery.
• It offers a universal language for surgeons to discuss complex cases and standardize diagnosis and treatment.
• Adoption of this classification has the potential to improve patient outcomes in revision ACL reconstruction.