Knee Surg & Relat Res 31, 10 (2019). - grafts that pass thru femoral tunnels develop more internal pressure at femoral attachment site than those passed over top because of sharp edge of the tunnel; Revision ACL graft failure rates were reported by 5 studies, including 1 study with ABM (6.1%), 1 study with AC (8.3%), 1 study with TBA (0%), and 2 studies with ICBG (0% and 2%). At a mean period of 33.9months, there was an improvement in the Lysholm score (77.215.5 vs 72.918.7), IKDC score (69.013.4 vs 69.313.4) and Tegner activity score (4.11.5 vs 4.61.2) for both groups. Biazzo A, Manzotti A, Motavalli K, Confalonieri N. J Clin Orthop Trauma. This adds a fair amount of complexity to the procedure. a meta-analysis of 32 studies. official website and that any information you provide is encrypted - ref: Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. Methods: <> Clinically, many authors have reported good results for two-staged revision ACLR using autograft bone [4, 11]. 3. - Discussion: Would you like email updates of new search results? Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. Make a donation. registered for member area and forum access. Griffith TB, et al. The results from this group were compared to the results of a matched group of patients with primary ACLR. Unable to load your collection due to an error, Unable to load your delegates due to an error. Given our prior assumption of the STC being 45 mm, the graft-50 rule suggests a 45-mm tibial tunnel if using 25-mm bone plugs. Am J Sports Med 34:553564, MARS Group, Wright RW, Huston LJ, Spindler KP, Dunn WR, Haas AK et al (2010) Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. -Femoral tunnel placement in single-bundle anterior cruciate ligament reconstruction: a cadaveric study relating transtibial lateralized femoral tunnel position to the anteromedial and posterolateral bundle femoral origins of the anterior cruciate ligament.. At Mayo Clinic, we have the imaging, surgical and physical therapy teams to manage extremely complex knee issues. Am J Sports Med 43:121127, Carson EW, Anisko EM, Restrepo C, Panariello RA, O'Brien SJ, Warren RF (2004) Revision anterior cruciate ligament reconstruction: etiology of failures and clinical results. In the immediate postoperative period, the weakest part of any ACLR is the fixation. Unfortunately, both previous reconstructions were performed with allograft (cadaver) tissue, which has been shown to have significantly higher failure rates in young patients compared with autograft (the patient's own tissue). Our Experience: 2014 - 2018 . - Editorial: The Lateral Intercondylar RidgeA Key to Anatomic Anterior Cruciate Ligament Reconstruction Comparison of Femoral Tunnel Position and Clinical Results. - some create a trough in the femur to bring graft closer to anatomical position, or they fix graft in place w/ knee in full extension; Varying Femoral Tunnels Between the Anatomical Footprint and Isometric Positions: Effect on Kinematics of the Anterior Cruciate Ligament-Reconstructed Knee. Bethesda, MD 20894, Web Policies 2020;38:1191. Data extracted included indications for 2-stage surgery, surgical technique, graft material, time between surgeries, rehabilitation protocols, physical examination findings, patient-reported outcomes, and radiographic and histologic findings. government site. Please enable it to take advantage of the complete set of features! 2023 BioMed Central Ltd unless otherwise stated. Root tears also put tremendous forces on the ACL graft and can lead to rotational instability and graft failure. JavaScript is disabled. Two-stage revisions are rarely performed, but are particularly useful when addressing substantial tunnel-widening, active infection, and concomitant knee pathology (e.g., malalignment, other ligamentous injuries, meniscal or chondral lesions). Some authors suggest that an accelerated rehabilitation program for revision ACLR is not appropriate because of weaker initial graft fixation [20]. Mayo Clinic sports medicine surgeons routinely perform revision surgery for patients who have undergone one or more ACL reconstructions elsewhere, and have published extensively on this topic. Approximately 200,000 anterior cruciate ligament (ACL) ruptures occur in the United States annually. endobj We describe a new technique for femoral and tibial tunnel impaction grafting in 2-stage ACL revisions, using the OATS grafting instruments (Osteochondral Autologous Transfer System; Arthrex, Naples, FL). Arthroscopy 21:767, Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. - tunnel positioning: In active young patients, failed primary ACLR may require a revision ACLR. MeSH Secure graft fixation is critical in ensuring a successful two-staged ACLR. 2002 Richard O'Connor Award paper. There are several procedures that can be performed in the ACL revision setting, such as anterolateral ligament reconstruction and iliotibial band tenodesis, to control that rotation. Enjoy a guided tour of FindACode's many features and tools. Kim, DH., Bae, KC., Kim, DW. Current studies report an average-low failure rate of 3.6% (wide range of 08.1%) for utilizing two-stage revision ACLR [11, 33, 34, 42, 43] (Table2). He did other procedures, but I have the codes for them. performed a CT scan at 4months to assess healing of the bone graft in the tibial tunnel. In 2 studies, the authors investigated the outcomes of allograft: allograft bone matrix (ABM) and allograft bone chips (AC). [31] used Si-CaP for a bone-graft substitute for tunnel augmentation in two-stage revision ACLR. Patients who underwent ACL reconstruction (Current Procedural Terminology (CPT) code 29888) between 20 were identified using the PearlDiver database. Few studies report the outcomes of two-stage revision ACLR alone. Resurfacing technique consisting of transplantation of multiple osteochondral grafts to smooth the area. The site is secure. Federal government websites often end in .gov or .mil. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. An official website of the United States government. You must log in or register to reply here. Revision ACL surgery: A comprehensive approach. Typically, a staged procedure requires an average delay of 4 to 6months to allow for the bone defect to heal [11, 18], likely subjecting patients to a prolonged period of knee instability and thus adding to the risk of meniscal injury, additional deterioration of muscle strength, and osteochondrosis [32]. Varus or valgus malalignment can put strain on an ACL graft, whatever the malalignment's cause the patient's physiology, failed meniscal surgery or cartilage problems. $.' Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. Arthroscopy 33:819827, Diamantopoulos AP, Lorbach O, Paessler HH (2008) Anterior cruciate ligament revision reconstruction: results in 107 patients. Improved muscle strength may be the decisive factor; however, changes in functional movement patterns after intensive physical therapy are also important to consider [41]. registered for member area and forum access. Bone and Joint Clinic. anterior cruciate ligament; bone graft; knee; revision. FOIA Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. Study design: A patient with a left knee anterior cruciate ligament tear, torn lateral meniscus and retained hardware from a previous anterior cruciate ligament reconstruction presented for a left knee arthroscopic anterior cruciate ligament repair, open removal of retained hardware and bone grafting of the distal femur and tibial tunnels.Following the doi: 10.1016/j.eats.2020.08.024. - ACL graft should pull up intotibial tunnel by about 2mm with extension when fixed on femoral side; ACL reconstruction is surgery to replace a torn anterior cruciate (KROO-she-ate) ligament (ACL) a major ligament in your knee. I wanted to see the history here to better define the stages of reconstruction and see the indication for the procedure being performed in this stage. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. The second stage of the revision ACLR was performed a minimum of 3 months later, after obtaining a CT demonstrating adequate filling of the tunnels using a hamstring autograft though a transtibial drilling technique. MARS Group. Bone Grafting Technique in Revision ACL Reconstruction: Coring Reamer and Dowel Trick. The purpose of this article is to review the preoperative planning, surgical considerations, rehabilitation, and outcomes of two-stage revision ACL reconstructions and summarize the recent literature outlining treatment results. Tibial Tunnel Bone Allograft Cpt Code For The. - this represents the closest reconstitution of the ACL's "physiometry"; (see: isometry); Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? -increased risk of critically short tunnels (<25 mm) and posterior tunnel wall blowout when a conventional offset guide is used Allograft bone grafting femoral an Tibial Tunnels, with Debridement of Tunnels The previous ACL graft was debrided with the use of a shaver. Reflex extension loss afteranterior cruciate ligamentreconstruction due to femoral "high noon" graft placement. Preoperative planning for revision ACL surgery is essential for a successful outcome. By using this website, you agree to our Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up. and transmitted securely. Additionally, graft-tunnel mismatch is problematic, often leading to inadequate osseous . An official website of the United States government. A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. 2002 Richard O'Connor Award paper. Femoral and Tibial Tunnel Bone Grafting for Stage 1 Revision ACL Reconstruction 10,878 views Apr 25, 2017 NewYorkOrtho 25K subscribers Notice. 2021 Oct 12;11(4):e20.00055. PubMedGoogle Scholar. Primary ACL reconstruction is recognized as a successful procedure, but failure has been shown to occur in approximately 10% of patients. Orthop Traumatol Surg Res 103:S223S2S9, Lee DW, Kim JG, Cho SI, Kim DH (2019) Clinical outcomes of isolated revision anterior cruciate ligament reconstruction or in combination with anatomic anterolateral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:10591064, Bhatia S, Korth K, Van Thiel GS, Frank RM, Gupta D, Cole BJ et al (2016) Effect of tibial tunnel diameter on femoral tunnel placement in transtibial single bundle ACL reconstruction. 6 0 obj Morphometric analysis of femoral and tibial tunnel locations revealed that the two procedures were based on the same anatomical concept, and BPTB grafts showed significantly better anterior knee stability than HT grafts, although no significant differences in other objective evaluations and all subjective evaluations were detected between the two graft types in anatomical ACLR. A 17-year-old female came to see us after two failed ACL surgeries. The insertion of an interference screw not only compresses the graft in the tunnel but also leads to an enlargement of the bone tunnel itself [13]. The .gov means its official. You are using an out of date browser. - graft was placed on the femoral site in the high noon position combined with a slight medial tibial tunnel placement; ACL injuries most commonly occur during sports that involve sudden stops and changes in direction such as soccer, football, basketball and volleyball. and transmitted securely. Noyes et al. Ligaments are strong bands of tissue that attach one bone to . - posterior placement or distal to normal site of attachment results in excessive tightening of the graft when knee is extended; femoral tunnel too far anterior in the notch; Lee et al. Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after anterior cruciate ligament injury.The torn ligament is removed from the knee before the graft is inserted through a hole created by a single hole punch. The bone grafting is an opportune time to do an osteotomy to correct the malalignment. JFIF C Federal government websites often end in .gov or .mil. Arthrosc Tech. For a better experience, please enable JavaScript in your browser before proceeding. JavaScript is disabled. The optimal and earliest possible timing of the two-stage procedure is still not clear. A decision that will often depend on the graft used during the primary ACLR. To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. https://doi.org/10.1186/s43019-019-0010-6, DOI: https://doi.org/10.1186/s43019-019-0010-6. Cancel anytime. proprioceptive reflex leading to a functional extension loss while the patient is awake. For the aforementioned reasons, in this review, we will provide an overview of two-stage revision ACLR in the following order: preoperative planning, surgical considerations, rehabilitation, outcomes, and conclusions. Arch Orthop Trauma Surg 132:12991313, Thomas NP, Kankate R, Wandless F, Pandit H (2005) Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel. Epub 2018 Feb 23. The .gov means its official. A Retrospective Comparative Study 3 0 obj A relatively small but challenging subset of patients requires two-stage revision ACLR. - anterior graft placement (relative to normal anatomical insertion of ACL) results in high strain on graft as knee is flexed; -allows the femoral attachment point to overlap the anterolateral and posteromedial bundles insertion site For a better experience, please enable JavaScript in your browser before proceeding. Predictors of clinical outcome following revision anterior cruciate ligament reconstruction. The metaphyseal location and predominantly cancellous bone surrounding the graft tissue result in high osteoinductive and osteogenic potential from the hosts bone marrow [26]. Philippe C, Marot V, Courtot L, Mesnier T, Reina N, Cavaignac E. Arthrosc Tech. Overview. TECHNIQUE STEPS. What code(s) would be reported for the open removal of retained deep hardware, along with placement of bone graft to the femur and tibial tunnels? Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery. Two-stage revision ACLR should be considered in cases of tunnel lysis, infection, malalignment, meniscal deficiency, or chondral lesions. - Surgical Technique: Purposes: We sought to introduce our new technique of Bashti bone plug for fixation of soft tissue graft in anterior cruciate ligament (ACL) reconstruction and to compare . They noted that although additional lateral tenodesis did not influence the International Knee Documentation Committee (IKDC) score in a multicenter study of 163 revision ACLRs, the proportion of negative pivot shifts was 80% with lateral tenodesis plus revision ACLR versus 63% without tenodesis. Disclaimer. Patrick C. McCulloch MD. - w/a right knee, place the tunnel at about the 9:30 to 10 oclock position; 110 West Rd., Suite 227 Epub 2016 Dec 30. While one-stage revision ACLR is well described and reported, few studies have reported the outcomes of two-stage revision ACLR. 2017 Jun;99-B(6):714-723. doi: 10.1302/0301-620X.99B6.BJJ-2016-0929.R2. Patient age and activity level are also important factors when deciding on graft choice for revision procedures. To read the full article, sign in and subscribe to the AHA Coding Clinic for HCPCS. doi: 10.2106/JBJS.ST.20.00055. [39] have demonstrated that 349 patients who underwent revision ACLR-combined-ALL reconstructions showed improving rotational stability without increasing the risk of early and late complications and the re-rupture rate was 1.2% in their multicenter study. - A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction A total 75 patients (75 knees) who underwent ACL reconstruction with tibialis anterior allografts were investigated between February 2015 and October . Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. Often the meniscus hasn't healed after the initial surgery, or lesions might have been overlooked during surgery, in particular meniscal root tears or meniscal ramp lesions. Clin Orthop Relat Res. Postoperatively, no complications were reported and none of the included patients had a flexion or extension deficit. Stage II lateral root tear, lateral root repair and repeat revision back-to-back ACL repair. Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. J Bone Joint Surg Am 100:9931000, Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. eCollection 2020 Dec. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. All rights reserved. American Journal of Sports Medicine. 4 0 obj A Retrospective Comparative Study. Careers. 2022 May 11;11(6):e971-e976. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. Coronal (a) and sagittal (b) view of computed tomography (CT) images demonstrate widening of the tibial tunnel in the setting of a failed anterior cruciate ligament reconstruction. Pre-op imaging shows excessive tunnel and socket widening and no malalignment with normal slope. BMC Musculoskelet Disord 19:246. They observed that the the failure rate was 10.3% in the one-stage revision group and 6.1% in the two-stage group. Example: 29888 - ACL Repair G0289 - Arthroscopy, knee, surgical, for removal of loose body, Harvesting and inserting the graft is included in code . Correspondence to Allografts may be well suited for recreational athletes older than 30years of age, but autografts may be a better choice for younger athletes who wish to return to higher-level athletics [4]. Arthrosc Tech. HHS Vulnerability Disclosure, Help A new harvest site for bone graft in anterior cruciate ligament revision surgery. 2021 Oct 12;11(4):e20.00055. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. Recently, we recognized that patients needing ACL reconstruction who also have significant rotatory instability of the knee may have injuries in the anterolateral complex. Neil Duplantier MD. Measurements are made perpendicular to the axial plane of the tunnel at the widest point. Bone grafting is commonly reported using iliac crest autograft and allograft bone chips and dowels, while hamstring autograft and BPTB autograft were the most utilized grafts during the second-stage definitive reconstruction. Preoperative Patient Care. In additional analyses, 24% (12/49) of patients were newly found to have concomitant knee injuries (e.g., chondral defects, meniscal lesions) at the time of the second-stage operative procedure. One-Stage ACL Revision Using a Bone Allograft Plug for a Semianatomic Tibial Tunnel That Is Too Anterior. Patients were divided into the isolated revision ACLR group (n=45) and the revision ACLR group in combination with ALL reconstruction (n=42). 2003 Jan;34(1):49-64. doi: 10.1016/s0030-5898(02)00070-6. We NEVER sell or give your information to anyone. Previous literature has reported that if the tunnel size exceeds 1015mm, two-stage surgery should be performed. Bone tunnel-related issues are frequently encountered during revision anterior cruciate ligament reconstruction. Bone Graft related CPT Codes. government site. If any of those ligaments were missed in the initial knee surgery, they can be treated in the revision setting. A patient with a left knee anterior cruciate ligament tear, torn lateral meniscus and retained hardware from a previous anterior cruciate ligament reconstruction presented for a left knee arthroscopic anterior cruciate ligament repair, open removal of retained hardware and bone grafting of the distal femur and tibial tunnels.Following the arthroscopic anterior cruciate ligament repair, a tibial incision was made through subcutaneous tissue to access the tibial tunnel in order to remove the deep hardware. 2020;48(3):767-777. Comparison of Femoral Tunnel Position and Clinical Results. 4. Two-Stage Revision Anterior Cruciate Ligament Reconstruction with Cannulated Allograft Bone Dowels Soaked in Bone Marrow Aspirate Concentrate. 2007 May;23(5):558.e1-4. The femoral tunnel was a little high. ",#(7),01444'9=82. doi: 10.1016/j.eats.2021.08.013. These lesions are often difficult to see on MRI. In 2-stage revisions, bone grafting of the tunnels may be undertaken if the primary position was inaccurate or if osteolysis has caused widening of the tunnels. eCollection 2020 Dec. Prall WC, Kusmenkov T, Schmidt B, Frmetz J, Haasters F, Naendrup JH, Bcker W, Shafizadeh S, Mayr HO, Pfeiffer TR. However, methods used to sterilize allograft material (e.g., gamma irradiation and autoclaving), are known to adversely affect the structural and other properties of the graft material [25]. - resulting anterior-posterior cruciate ligament impingement near extension caused a persistentfunctional extension deficit of 20; in 30 deg flexion at the time of final fixation may result inexcessive graft tension when the knee is position in full extension; - historic techniques: statement and My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. Knee-laxity measurements were elevated in the without-revision group, but the difference was not significant. Google Scholar, van Eck CF, Schkrohowsky JG, Working ZM, Irrgang JJ, Fu FH (2012) Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft. This adds a fair amount of complexity to the procedure. Knee 23:830836, MARS Group (2014) Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the Multicenter ACL Revision Study (MARS) Cohort. Department of Orthopaedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 1035 Dalgubul-ro, Dalseo-gu, Daegu, 42601, South Korea, Du-Han Kim,Ki-Cheor Bae,Dong-Wan Kim&Byung-Chan Choi, You can also search for this author in With each added degree of inclination, one gains 0.68 mm of tibial tunnel length. [11] reported the results of 49 consecutive two-stage revision ACLRs in which the tibial tunnel was grafted (the bone graft was taken from the ipsilateral iliac crest) during the first stage, followed by an ACLR using various grafts and fixation methods for the second stage. Arthrosc Tech. Rehabilitation after the initial bone-grafting stage shares similarities with standard ACLR protocols [17]. Your going to need to get very familiar with 2017 CMS NCCI Surgical Policy Manual. Clifford R. Wheeless, III, M.D. Drilling the Femoral Tunnel During ACL Reconstruction: Transtibial Versus Anteromedial Portal Techniques. The surgeon submitted CPT code 25431 alone. Stage I femoral and tibial bone grafting. Enhancement of tendon-to-bone healing after anterior cruciate ligament reconstruction using bone marrow-derived mesenchymal stem cells genetically modified with bFGF/BMP2. Tunnel malpositioning that will interfere with new revision reconstruction tunnel placement can reduce graft apposition within the tunnels at the time of graft fixation, thereby placing the graft stability and subsequent incorporation at greater risk of failure [11]. Conclusion: This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. Knee Surg Sports Traumatol Arthrosc 24:5157, Chahla J, Dean CS, Cram TR, Civitarese D, OBrien L, Moulton SG et al (2016) Two-stage revision anterior cruciate ligament reconstruction: bone grafting technique using an allograft bone matrix. Mosaicplasty. Studies have shown that CT outperforms magnetic resonance imaging (MRI) and radiographs in both inter- and intra-observer reliability for evaluating tunnel-widening [14, 15]. Two years after the surgery, she resumed all activities and plays collegiate volleyball. Tunnel malpositioning and widening remain the most common indications for two-stage revision ACLR. HHS Vulnerability Disclosure, Help Unfortunately, the most common cause for failure is related to technical issues from the primary ACL surgery, with malposition of the sockets and tunnels, particularly on the femoral side. Arthroscopic knee procedure CPT codes range from 29866 to 29889. Am J Sports Med 40:800807, Article Thomas NP, Kankate R, Wandless F, Pandit H. Am J Sports Med. Background: Ligament reconstruction is a common procedure in orthopedic surgery. We want our patients to be able to return to the activities they enjoy. Sci Rep (2016) - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. Optimal outcomes require a precise picture of how the ACL reconstruction failed. There are numerous challenges to revision ACL surgery with regard to graft selection, timing of surgery, and whether or not the surgery can be performed in a single operation or multiple-staged surgeries. Knee Surg Sports Traumatol Arthrosc 21:20722080, Magnussen RA, Debieux P, Benjamin B, Lustig S, Demey G, Servien E et al (2012) A CT-based classification of prior ACL femoral tunnel location for planning revision ACL surgery. Google Scholar, Group M, Ding DY, Zhang AL, Allen CR, Anderson AF, Cooper DE et al (2017) Subsequent surgery after revision anterior cruciate ligament reconstruction: rates and risk factors from a multicenter cohort. Springer Nature. To date, the literature on revision ACLR surgery has primarily focused on comparing the outcomes to those of primary ACLR. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. Predictors of clinical outcome following revision anterior cruciate ligament reconstruction. There was also a significant improvement in the Lysholm score when comparing preoperative and postoperative values. <> Then in that case, yes, I would code this as 29888-52. Ramp tears can lead to rotational instability and put excessive strain on the ACL graft, causing it to fail. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Bethesda, MD 20894, Web Policies Bone Incorporation of Silicate-Substituted Calcium Phosphate in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic and Radiographic Study. That would help me to provide some better guidance. What other specialized procedures might be performed in conjunction with ACL revision surgery? Am J Sports Med 42:23012310, Noyes FR, Barber-Westin SD, Roberts CS (1994) Use of allografts after failed treatment of rupture of the anterior cruciate ligament.
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