Purpose: Background: registered for member area and forum access. Arthroscopy 33:819827, Diamantopoulos AP, Lorbach O, Paessler HH (2008) Anterior cruciate ligament revision reconstruction: results in 107 patients. As this number has continued to increase, the incidence of revision ACL reconstruction (ACLR) has also grown to a rate of between 4.1 and 13.3% of all primary ACLRs performed [2]. Unable to load your collection due to an error, Unable to load your delegates due to an error. i came across this in cpt a revision acl reconstruction and i came anterior, price 8 900 cpt code 29888 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 The femoral tunnel was easily visualized with flexing the knee beyond 90 degrees. - under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a endobj Orthopedics 39:e456e464, Noyes FR, Barber-Westin SD (2006) Anterior cruciate ligament revision reconstruction: results using a quadriceps tendon-patellar bone autograft. 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. 2021 Oct 12;11(4):e20.00055. MeSH This case required a two-stage approach: Stage 1 consisted of bone grafting, followed by second-stage repeat revision ACL reconstruction with patellar tendon autograft, lateral meniscal root repair and iliotibial band tenodesis. Data Trace is the publisher of A lot of factors help us to determine whether a single revision or a two- or multiple-stage revision would be best for a particular patient. 2022 Feb 28;11(3):e463-e469. Similarly, root tears of the lateral meniscus are often missed as well. A relatively small but challenging subset of patients requires two-stage revision ACLR. Biazzo A, Manzotti A, Motavalli K, Confalonieri N. J Clin Orthop Trauma. - in the report byStrobel MJ, et al., the authors report a case of a painful reflex extension loss due tofemoral malplacement of anACLgraft in a female high-level athlete; Knee Surg & Relat Res 31, 10 (2019). 29866 is for autografts (from the patient). sharing sensitive information, make sure youre on a federal Spine (Phila Pa 1976) 20:10551060, Campbell DG, Li P (1999) Sterilization of HIV with irradiation: relevance to infected bone allografts. Tunnel malpositioning and widening remain the most common indications for two-stage revision ACLR. Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. Two-stage revision ACLR typically involves an initial bone-graft procedureto fill the widened or misplaced tunnelsand subsequent time to allow for the bone graft to heal sufficiently before the second stage is undertaken [5]. At Mayo Clinic, we sometimes correct the alignment before performing revision ACL surgery, to prevent graft failure. An official website of the United States government. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. Example: 29888 - ACL Repair G0289 - Arthroscopy, knee, surgical, for removal of loose body, Harvesting and inserting the graft is included in code . 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]. Bone graft, any donor area; minor or small eg, dowel or button) (20900) Bone graft, any donor area; major or large (20902) Insertion vascular pedicle into carpal bone (25430) Bone marrow; aspiration only (38220) Bone marrow transplantation; autologous (38241) Microvascular. doi: 10.2106/JBJS.ST.20.00055. 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. The new ligament was fixed to the tibia by a metallic screw and to the femur by a bioabsorbable screw. Thomas et al. Data Trace Publishing Company ]+yC`6Hd Ql]M 3w7ah;HNdyS*7x-zq^/4%^6eA$m@(,ly}U[N9E(/=iHCL")d6yx]K7!84,q!r~#6mE8dIS69eYn 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]. The authors declare that they have no competing interests. proprioceptive reflex leading to a functional extension loss while the patient is awake. Patients who underwent ACL reconstruction (Current Procedural Terminology (CPT) code 29888) between 20 were identified using the PearlDiver database. eCollection 2021 Dec. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. Am J Sports Med 38:19791986, Dye SF (1996) The future of anterior cruciate ligament restoration. Inferior tendon graft to bone tunnel healing at the tibia compared to that at the femur after anterior cruciate ligament reconstruction. Uchida et al. ",#(7),01444'9=82. Two-stage revision anterior cruciate ligament reconstruction: a systematic review of bone graft options for tunnel augmentation. eCollection 2021 Oct-Dec. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The femoral tunnel was a little high. Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) using bone-tendon-bone (BTB) autograft is associated with increased postoperative anterior knee pain and pain with kneeling and has the risk of intra- and postoperative patellar fracture. NPI Look-Up Tool (National Provider Identifier), The official publication for Level I HCPCS (CPT-4 codes) for hospital providers, Also specific Level II HCPCS codes for hospitals, physicians and other health professionals, Fully searchable through Find-A-Code's Comprehensive Search, Codes mentioned in articles are linked to Code Information pages, Code Information page link back to related articles. Radiographic evaluation of bone graft integration after the first stage was reported in 4 studies, with an average duration of 4.9 months. The site is secure. Disclaimer. Jul 22, 2009. The surgeon should be sure to "bottom out" the cannula stylet into the femoral tunnel and allow the bone graft to gently push the stylet out of the tunnel as it is being filled . 2013;41:1296. A clinical, prospective, randomized, double-blind study. However, an absolute threshold for how much tunnel-widening and bone loss is acceptable to undergo a single stage with an intraoperative bone graft prior to drilling has not been established [4, 16,17,18,19]. 2022 Jun 21;11(7):e1367-e1372. Before 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. Finally, 1 study compared ICBG to a synthetic bone substitute. endobj endobj Eur Spine J 22(Suppl 2):S185S194, von Recum J, Schwaab J, Guehring T, Grutzner PA, Schnetzke M (2017) Bone incorporation of silicate-substituted calcium phosphate in 2-stage revision anterior cruciate ligament reconstruction: a histologic and radiographic study. ACL Reconstruction - BTB Graft. [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. 2. eCollection 2020 Dec. Prall WC, Kusmenkov T, Schmidt B, Frmetz J, Haasters F, Naendrup JH, Bcker W, Shafizadeh S, Mayr HO, Pfeiffer TR. A new and innovative procedure. Mayo Clinic has vast experience treating posterior cruciate ligament, lateral collateral ligament, posterolateral and posteromedial corner injuries, as well as medial collateral ligament injuries. 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. Predictors of clinical outcome following revision anterior cruciate ligament reconstruction. 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. 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. With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. Purpose: To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. in 30 deg flexion at the time of final fixation may result inexcessive graft tension when the knee is position in full extension; Orthop Clin North Am. This study aims to identify potential factors for both femoral and tibial tunnel widening (TW) and to investigate the effect of TW on postoperative outcomes after anterior cruciate ligament (ACL) reconstruction with a tibialis anterior allograft. Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. reported that the laxity measurements achieved with a two-stage revision ACLR using autograft iliac bone could be similar to those achieved after primary ACLR and clinical improvement [11]. However, the results of the postoperative side-to-side differences of the Lachman test as well as the pivot-shift test were significantly superior in group A (<12mm). Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle 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]. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. 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. They reported that Si-CaP as a bone-graft substitute for tunnel augmentation showed favorable histologic, radiologic, and intraoperative integration comparable to the autologous iliac bone graft. All the patients in the study underwent screw removal and filling of the tunnels with an autograft harvested from the anterior tibial metaphysis. The goal is to ensure patients of all activity levels, from professional to recreational, have the surgeries that meet their individual needs. Lee et al. If this is your first visit, be sure to check out the. This site needs JavaScript to work properly. Tibial tunnel cysts, including pretibial cysts , are occasional complications of autologous or synthetic anterior cruciate ligament (ACL) reconstruction surgeries. A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction. 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. Results: Achieving the correct position can be tricky. 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. Systematic review. Christensen JJ, et al. There is no code for bone grafting. xMO@; aK]XDZ)r(-w(;.B ~8MG{ Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. <> <> Background: No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. Louis et al. In theory, the sCO2-sterilized graft only provides osteoconductive properties to the grafted bone tunnels. - Discussion: To read the full article, sign in and subscribe to the AHA Coding Clinic for HCPCS. They observed that revision ACLR in combination with ALL reconstruction significantly reduced rotational laxity and showed a higher rate of return to the same level of sports activity than revision ACLR alone, although there were no significant differences in anterior laxity or functional test results between the two groups. Unauthorized use of these marks is strictly prohibited. official website and that any information you provide is encrypted Previous literature has reported that if the tunnel size exceeds 1015mm, two-stage surgery should be performed. - this technique allows for a more anatomic and precise placement of the femoral tunnel (more reliable posterior placement); 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. Federal government websites often end in .gov or .mil. Recently, a technique for sterilizing musculoskeletal allografts using supercritical carbon dioxide (sCO2) has been developed [26]. -notchplasty Am J Sports Med 45:20682076, Erickson BJ, Cvetanovich G, Waliullah K, Khair M, Smith P, Bach B Jr et al (2016) Two-stage revision anterior cruciate ligament reconstruction. Franceschi F, Papalia R, Di Martino A, Rizzello G, Allaire R, Denaro V. Arthroscopy. - 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; - makesure that interference screws are less than 25 mm in length; Primary ACL reconstruction is recognized as a successful procedure, but failure has been shown to occur in approximately 10% of patients. Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. Bone Incorporation of Silicate-Substituted Calcium Phosphate in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic and Radiographic Study. Am J Sports Med 32:543549, Groves C, Chandramohan M, Chew C, Subedi N (2013) Use of CT in the management of anterior cruciate ligament revision surgery. Two-stage revision ACLR typically involves an initial bone-graft procedureto fill the widened or misplaced tunnelsand subsequent time to allow for the bone graft to heal sufficiently before the second stage is undertaken [ 5 ]. 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). CAS Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. View all the articles associated with any code, right from the code page. Privacy By using this website, you agree to our CT examinations were performed at 3, 12, and 24weeks after bone grafting. With each added degree of inclination, one gains 0.68 mm of tibial tunnel length. However, Thomas et al. A single copy of these materials may be reprinted for noncommercial personal use only. -main criticism is that in some cases a transtibial tunnel will not allow for the exact desiredtunnel placement (you get what you get) Hello, our physician bone grafted the previous ACL tunnels with allograft via arthroscopy. MARS Group. Epub 2018 Dec 17. Mosaicplasty. However, many authors prefer using an autograft for revision ACLR when possible. Sorry. You must log in or register to reply here. Biomaterials 27:50145026, Hing KA, Wilson LF, Buckland T (2007) Comparative performance of three ceramic bone graft substitutes. Title: Slide 1 Author: Charles H Brown Created Date: 12/3/2018 11:52:05 AM . - anterior graft placement (relative to normal anatomical insertion of ACL) results in high strain on graft as knee is flexed; - surgeon will also note more perpendicular drill angle to bone surface with AM vs TransTibial drilling; Is it appropriate to assign codes for both the arthroscopic and open portions of the procedure? 1998-2023 Mayo Foundation for Medical Education and Research. CT scans to confirm healing at 3-5months after bone grafting [4, 12, 33, 34]. They explained that because a bone tunnel of 15mm diameter with 45 of inclination resulted in a tibial tunnel aperture of >20mm, a 20-mm tunnel aperture was regarded as a candidate for grafting. Yoon et al. Autograft was used in 4 studies: iliac crest bone autograft (ICBG, n = 3) and tibial bone autograft (TBA, n = 1). - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. Several Mayo Clinic orthopedic surgeons are members of the Multicenter ACL Revision Study (MARS) Group, which has authored a series of reports on topics including predictors of clinical outcomes, published in Journal of Orthopaedic Research in 2020. I am still awaiting the OP note from the ASC, which takes weeks, so I can't post it. doi: 10.1016/j.eats.2021.08.013. - ACL graft should pull up intotibial tunnel by about 2mm with extension when fixed on femoral side; - over the top repair tensioned in extension will provide support in terminal extension but may slacken at greater flexion angles; performed a CT scan at 4months to assess healing of the bone graft in the tibial tunnel. 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? Aust N Z J Surg 69:517521, Eagan MJ, McAllister DR (2009) Biology of allograft incorporation. endstream Careers. Battaglia and Miller [12] indicated that bone grafting should be performed in cases with a tunnel diameter of 1015mm. Am J Sports Med 36:851860, Franceschi F, Papalia R, Del Buono A, Zampogna B, Diaz Balzani L, Maffulli N et al (2013) Two-stage procedure in anterior cruciate ligament revision surgery: a five-year follow-up prospective study. Learn how to get the most out of your subscription. Bone Graft related CPT Codes. The important stages in assessing a patient with failed ACL surgery include history, patient selection, physical examination and investigations, choice of graft, surgical technique, and rehabilitation [7]. We NEVER sell or give your information to anyone. Clinically, many authors have reported good results for two-staged revision ACLR using autograft bone [4, 11]. Comparison of Femoral Tunnel Position and Clinical Results. Knee-laxity measurements were elevated in the without-revision group, but the difference was not significant. - most common error is non isometric anterior tunnel placement within intercondylar notch rather than at its normal posterior insertion; To minimize the risk of viral and bacterial contamination, allograft bone is sterilized. [21] evaluated 88 patients who underwent one-stage revision ACLR. Van de pol et al. <> 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. This process is repeated until there is full fill of femoral tunnel. 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). Improved muscle strength may be the decisive factor; however, changes in functional movement patterns after intensive physical therapy are also important to consider [41]. Epub 2018 Feb 23. 2017 Apr;33(4):819-827. doi: 10.1016/j.arthro.2016.10.007. Use of silicate-substituted calcium phosphate bone substitute had equivalent knee laxity and clinical function outcomes compared with autologous bone graft 3 years after two-stage ACL . Spine J 7:475490, Jenis LG, Banco RJ (2010) Efficacy of silicate-substituted calcium phosphate ceramic in posterolateral instrumented lumbar fusion. The .gov means its official. Tibial Tunnel Bone Allograft Cpt Code For The. It does not hit an edit, but be prepared for insurance to deny it. sharing sensitive information, make sure youre on a federal Measurements are made perpendicular to the axial plane of the tunnel at the widest point [15]. The initial rehabilitation emphasis is focused on restoring tibiofemoral and patellofemoral passive range of motion, restoring quadriceps activation, and controlling and resolving any joint effusion. A clinical, prospective, randomized, double-blind study, Femoral Shaft Frx: Leg Lengths / Nail Lengths, Orthopaedic Specialists of North Carolina. 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. 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. For an allograft, a single bone dowel approximately 1mm larger than the diameter of the tunnel is used and placed using a bone tamp for a press-fit technique, ensuring that the entire tunnel is filled [4]. 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. Am J Sports Med 33:17011709, Battaglia TC, Miller MD (2005) Management of bony deficiency in revision anterior cruciate ligament reconstruction using allograft bone dowels: surgical technique. J Orthop Sci (2010) . Recently, we recognized that patients needing ACL reconstruction who also have significant rotatory instability of the knee may have injuries in the anterolateral complex. government site. Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. In active young patients, failed primary ACLR may require a revision ACLR. 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]. Anterior cruciate ligament reconstruction, Ohly NE, Murray IR, Keating JF (2007) Revision anterior cruciate ligament reconstruction: timing of surgery and the incidence of meniscal tears and degenerative change. Tunnel widening is generally cavitary, frequently maximal in the mid-zone of the tibial tunnel. For example, patients may require bone grafting of prior graft tunnels, and then have the ACL revision in a second stage. 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). Anterior cruciate ligament (ACL) reconstruction remains the gold-standard treatment for young active patients with functional instability after an ACL injury. A two-stage revision involves an initial bone grafting procedure to fill the tunnels, followed at least . - this restricts flexion of knee if graft remains intact, or it may elongate graft if the range of motion is restored; The optimal and earliest possible timing of the two-stage procedure is still not clear. Optimal outcomes require a precise picture of how the ACL reconstruction failed. Does the type of graft affect the outcome of revision anterior cruciate ligament reconstruction? Remaining soft tissue was debrided along tibia. - figure four flexedpositionassist with providing the best femoral target; In the immediate postoperative period, the weakest part of any ACLR is the fixation. - ACL position is lower and more horizontal than that achieved when performing the transtibial (TT) procedure. No charge. Int Orthop 37:13691374, Uchida R, Toritsuka Y, Mae T, Kusano M, Ohzono K (2016) Healing of tibial bone tunnels after bone grafting for staged revision anterior cruciate ligament surgery: a prospective computed tomography analysis. Wheeless' Textbook of Orthopaedics. Bone and Joint Clinic. 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. A new harvest site for bone graft in anterior cruciate ligament revision surgery. 8 Therefore, one should avoid angles <40 to 45 . The available data indicate that autograft for bone tunnel grafting in 2-stage ACL revision may be associated with a lower risk of revision ACL reconstruction graft failure compared with allograft bone. He did other procedures, but I have the codes for them. - anteromedial portal technique: ACL graft can replicate the normal ligament's tension curve. anterior cruciate ligament; bone graft; knee; revision. 2015;43:2510. The .gov means its official. doi: 10.1016/j.eats.2022.03.024. - two incision technique (outside in) I added CPT code 20902 after reviewing the operative note, because the surgeon obtained the bone graft from a distant site via a separate incision. PubMedGoogle Scholar. Bone Grafting Technique in Revision ACL Reconstruction: Coring Reamer and Dowel Trick. Only 44 patients underwent a staged revision ACLR after bone grafting and 10 patients refused to undergo a revision ACLR. - Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling doi: 10.1016/j.arthro.2006.07.054. They observed that an average %PDF-1.5 femoral tunnel too far anterior in the notch; To date, the literature on revision ACLR surgery has primarily focused on comparing the outcomes to those of primary ACLR. Please enable it to take advantage of the complete set of features! It may not display this or other websites correctly. Federal government websites often end in .gov or .mil. https://doi.org/10.1186/s43019-019-0010-6, DOI: https://doi.org/10.1186/s43019-019-0010-6. It may not display this or other websites correctly. - Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. new ACL graft. (D-F) Coronal and axial computed tomography images showing bone tunnel dilatation (femoral, 15.7 mm; tibial, 9.8 mm). Meniscal tears are another contributing cause. Phys Ther 85:740749, PubMed Tunnel orientation and size are the most important causes related to the two-stage procedure, as these enlarged tunnels may complicate graft placement and fixation [11, 12]. 8600 Rockville Pike All authors have made substantial contributions to all of the following: (1): the conception and design of the study, (2) drafting the article or revising it critically for important intellectual content, and (3) final approval of the version to be submitted. FOIA Methods: Houston Methodist Orthopedics & Sports Medicine. Manage cookies/Do not sell my data we use in the preference centre. See our privacy policy. Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. 2022 May 11;11(6):e971-e976. Approximately 200,000 anterior cruciate ligament (ACL) ruptures occur in the United States annually. - lateral tunnel placement: The indications for staged ACL reconstruction and the rehabilitation protocol between stages need to be clearly established. An average Lysholm score at 2 years post operation was 96.6 points 2.1 (91100 points). Preoperative planning is critical to identify and characterize bone tunnel pathology. 2007 May;23(5):558.e1-4. Increasing expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions require precise knowledge of technical details such as minimum intra-femoral tunnel graft lengths. Bethesda, MD 20894, Web Policies [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. Salem HS, Axibal DP, Wolcott ML, et al. There has been a long-standing debate as to whether an autograft or an allograft should be used for revision ACLR. Reports suggest that a two-stage procedure is performed in only 8 to 9% of revision ACLRs [6].
