Previous literature has reported that if the tunnel size exceeds 1015mm, two-stage surgery should be performed. Bone Grafting Tibial and Femoral Tunnels knee Portion of op note reads as follows: ACL was completely absent in mid aspect. Improved muscle strength may be the decisive factor; however, changes in functional movement patterns after intensive physical therapy are also important to consider [41]. In 2 studies, the authors investigated the outcomes of allograft: allograft bone matrix (ABM) and allograft bone chips (AC). <> Christensen JJ, et al. Preoperative planning is critical to identify and characterize bone tunnel pathology. % Please enable it to take advantage of the complete set of features! Tunnel malpositioning and widening remain the most common indications for two-stage revision ACLR. You are using an out of date browser. - graft that tightens (pulls up into the tibial tunnel) with flexion will have a much higher likelyhood offailure and usually indicates a The patients were divided into two groups based on the tunnel diameter (group A, <12mm; group B, <12mm). ACL reconstruction is surgery to replace a torn anterior cruciate (KROO-she-ate) ligament (ACL) a major ligament in your knee. Franceschi et al. Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation, Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study, The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint, Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling, Anteromedial Portal vs Transtibial Drilling Techniques in Anterior Cruciate Ligament Reconstruction: Any Clinical Relevance? 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. This site needs JavaScript to work properly. Approximately 200,000 anterior cruciate ligament (ACL) ruptures occur in the United States annually. He is only grafting the bone. 8600 Rockville Pike and transmitted securely. Evaluations were performed in the axial plane of the tibia using three parameters (occupying ratio, union ratio, and bone mineral density). If this is your first visit, be sure to check out the. This adds a fair amount of complexity to the procedure. You must log in or register to reply here. Trojani et al. Study design: Systematic review. A decision that will often depend on the graft used during the primary ACLR. 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]. Unless the surgeon looks specifically for a ramp lesion at the time of ACL surgery, the lesion can be missed. ACL Reconstruction - BTB Graft. 2017 Oct;475(10):2459-2468. doi: 10.1007/s11999-017-5278-9. Discover how to save hours each week. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. Hello, our physician bone grafted the previous ACL tunnels with allograft via arthroscopy. 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. TECHNIQUE VIDEO. However, with precise indications, proper preoperative planning and operative-technique selection, two-stage revision ACLR can achieve favorable outcomes. Terms and Conditions, - over the top position: Bruce A. We routinely obtain hip-to-ankle AP X-rays to assess for any coronal plane malalignment. An official website of the United States government. Louis et al. Measurements are made perpendicular to the axial plane of the tunnel at the widest point. doi: 10.1016/j.eats.2020.08.024. 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. 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. See our privacy policy. (A, B) Anteroposterior and lateral knee radiographs showing bone tunnel positioning, widening, and retained biocomposite screw. In active young patients, failed primary ACLR may require a revision ACLR. MeSH 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. For example, patients may require bone grafting of prior graft tunnels, and then have the ACL revision in a second stage. Additionally, graft-tunnel mismatch is problematic, often leading to inadequate osseous . Epub 2018 Dec 17. This site complies with the HONcode standard for trustworthy health information: verify here. The primary outcome in 2 studies was graft incorporation (mean follow-up, 8.8 months), whereas the other 5 studies reported clinical outcomes with follow-up mean SD of 4.2 2.1 years. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. For a better experience, please enable JavaScript in your browser before proceeding. - Drilling the Femoral Tunnel During ACL Reconstruction: Transtibial Versus Anteromedial Portal Techniques. BMC Musculoskelet Disord 19:246. 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. My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. 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. Federal government websites often end in .gov or .mil. 2007 May;23(5):558.e1-4. They found that a sCO2-sterilized bone allograft showed graft incorporation and remodeling through creeping substitution. - historic techniques: 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. 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). [33] evaluated 30 patients who underwent two-staged ACLR revision procedure after a traumatic re-rupture of the ACL. Privacy 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 A clinical, prospective, randomized, double-blind study. (C) Sagittal magnetic resonance imaging showing insufficiency of the anterior cruciate ligament graft. 2015;43:2510. statement and 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 . The site is secure. We thank Eun-Ji Jeon and Min-Ji Kim for their support. 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. 4. 5 0 obj Tibial tunnel cysts, including pretibial cysts , are occasional complications of autologous or synthetic anterior cruciate ligament (ACL) reconstruction surgeries. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. The site is secure. Preoperative Patient Care. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. California Privacy Statement, No restrictions are placed on their range of motion and patients were allowed to weightbear on the affected leg using crutches [17]. Graft healing within the bone tunnel after anterior cruciate ligament (ACL) reconstruction is still a complex, poorly understood biological process that is influenced by multiple surgical and postoperative variables. For assessment of bone-graft incorporation, radiographs are routinely used. Patrick C. McCulloch MD. HHS Vulnerability Disclosure, Help 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. Kim, DH., Bae, KC., Kim, DW. xMO@; aK]XDZ)r(-w(;.B ~8MG{ Griffith TB, et al. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Neil Duplantier MD. The https:// ensures that you are connecting to the 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. endobj Houston Methodist Orthopedics & Sports Medicine. Am J Sports Med. The tibial tunnel looked to be in a good position. Levy, M.D., an orthopedic surgeon specializing in sports medicine at Mayo Clinic in Rochester, Minnesota, discusses Mayo's approach to revision ACL surgery. Would you like email updates of new search results? Clipboard, Search History, and several other advanced features are temporarily unavailable. - references: JavaScript is disabled. Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. Knee Surg Sports Traumatol Arthrosc 20:12981306, Brown CH Jr, Carson EW (1999) Revision anterior cruciate ligament surgery. Researchers randomly assigned 40 patients undergoing two-stage revision ACL reconstruction to receive either autologous iliac crest cancellous bone graft for tunnel grafting (control group; n=20) or silicate-substituted calcium phosphate in the form of sculptable microgranules (Actifuse MIS System, Baxter) as a bone graft substitute . [34] evaluated 10 consecutive patients who underwent staged revision ACLR using autogenous bone grafting and reported that all patients had a full range of motion of the knees, a negative Lachmann sign and negative pivot-shift test . 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]. The appropriately sized OATS harvester is chosen 1 mm larger than the tunnel size and is used to harvest bone graft from the iliac crest through a percutaneous approach. At Mayo Clinic, we frequently perform osteotomies to correct both sagittal plane and coronal plane deformity. Epub 2005 Aug 10. volume31, Articlenumber:10 (2019) Enhancement of tendon-to-bone healing after anterior cruciate ligament reconstruction using bone marrow-derived mesenchymal stem cells genetically modified with bFGF/BMP2. 8600 Rockville Pike However, many authors prefer using an autograft for revision ACLR when possible. Data Trace is the publisher of Recently, we recognized that patients needing ACL reconstruction who also have significant rotatory instability of the knee may have injuries in the anterolateral complex. The femoral tunnel was a little high. In cases like these your going to need to bill out "what you can" which in this case would be 20680. Google Scholar, Mitchell JJ, Chahla J, Dean CS, Cinque M, Matheny LM, LaPrade RF (2017) Outcomes after 1-stage versus 2-stage revision anterior cruciate ligament reconstruction. Drilling the Femoral Tunnel During ACL Reconstruction: Transtibial Versus Anteromedial Portal Techniques. Resurfacing technique consisting of transplantation of multiple osteochondral grafts to smooth the area. et al. Methods: Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. doi: 10.1016/j.eats.2022.03.024. The .gov means its official. - under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a MARS Group. Drilling a tibial tunnel at 40 degrees yields an average tunnel length of 45.442.18 mm. HHS Vulnerability Disclosure, Help 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. [40] reported the results of 87 patients who underwent revision ACLR with a follow-up of more than 3 years. Am J Sports Med 40:800807, Article eCollection 2021 Oct-Dec. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. Measurements are made perpendicular to the axial plane of the tunnel at the widest point [15]. 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. The patient also had an unrecognized complete disruption of her lateral meniscal root and excessively widened tunnels and sockets. Her alignment, tibial slope and cartilage were all normal. 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. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. Two-stage revision anterior cruciate ligament reconstruction: a systematic review of bone graft options for tunnel augmentation. 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. PubMed, EMBASE, and the Cochrane Library were queried through use of the terms anterior cruciate ligament and revision to identify all studies reporting outcomes of bone tunnel grafting in 2-stage revision ACL reconstruction. JFIF C The mean time between the two stages was 8.8months and in the second stage, bone-biopsy specimens were taken from the tibia. In addition, we obtain single leg knee-to-ankle lateral X-rays to assess for any sagittal plane malalignment as well as to look for excessive tibial slope. This content does not have an English version. Similarly, root tears of the lateral meniscus are often missed as well. performed a CT scan at 4months to assess healing of the bone graft in the tibial tunnel. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. - ACL graft should pull up intotibial tunnel by about 2mm with extension when fixed on femoral side; Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. National Library of Medicine Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. 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. [11] noted that this suggestion is unnecessary, as using a two-stage technique ensures that there is good-quality bone around the tunnels, and the initial graft fixation is as secure as in the primary reconstruction. - 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; Clin Sports Med 28:203214 vii, Islam A, Chapin K, Moore E, Ford J, Rimnac C, Akkus O (2016) Gamma radiation sterilization reduces the high-cycle fatigue life of allograft bone. doi: 10.2106/JBJS.ST.20.00055. The greater the tibial slope, the higher the risk of graft failure as our group found in a 2015 study in American Journal of Sports Medicine. Example: 29888 - ACL Repair G0289 - Arthroscopy, knee, surgical, for removal of loose body, Harvesting and inserting the graft is included in code . [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. Springer Nature. The authors declare that they have no competing interests. Before Ramp tears can lead to rotational instability and put excessive strain on the ACL graft, causing it to fail. 2022 Feb 28;11(3):e463-e469. sharing sensitive information, make sure youre on a federal 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). This process is repeated until there is full fill of femoral tunnel. 2002 Richard O'Connor Award paper. 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. - most common error is non isometric anterior tunnel placement within intercondylar notch rather than at its normal posterior insertion; stream 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%). 29866 is for autografts (from the patient). One of the main factors associated with tunnel enlargement is malposition of the tibial tunnel, which likely leads to graft micromotion. Sometimes we can perform a biplanar osteotomy to correct both planes of deformity at once. doi: 10.1016/j.eats.2022.01.004. - tunnel positioning: 2017 Jun;99-B(6):714-723. doi: 10.1302/0301-620X.99B6.BJJ-2016-0929.R2. If no autograft is available for revision surgery, they advise augmentation of the allograft with the lateral extra-articular iliotibial band procedure to reduce the high failure rate associated with the use of the allograft. Root tears also put tremendous forces on the ACL graft and can lead to rotational instability and graft failure. Arthroscopy 34:706713, Hing KA, Revell PA, Smith N, Buckland T (2006) Effect of silicon level on rate, quality and progression of bone healing within silicate-substituted porous hydroxyapatite scaffolds. You are using an out of date browser. Mayo Clinic has substantial experience with all of these procedures. It may not display this or other websites correctly. Bethesda, MD 20894, Web Policies doi: 10.1016/j.eats.2021.11.019. Achieving the correct position can be tricky. - posterior placement or distal to normal site of attachment results in excessive tightening of the graft when knee is extended; But an iliac-crest autograft is comparatively invasive with relatively high donor-site morbidity and the potential for insufficient yield quantities [11, 22]. Disclaimer. Two-stage revision ACLR should be considered in cases of tunnel lysis, infection, malalignment, meniscal deficiency, or chondral lesions. Disclaimer. Clipboard, Search History, and several other advanced features are temporarily unavailable. Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? They observed that an average Postoperatively, no complications were reported and none of the included patients had a flexion or extension deficit. Does the type of graft affect the outcome of revision anterior cruciate ligament reconstruction? Spine (Phila Pa 1976) 20:10551060, Campbell DG, Li P (1999) Sterilization of HIV with irradiation: relevance to infected bone allografts. Clifford R. Wheeless, III, M.D. -main criticism is that in some cases a transtibial tunnel will not allow for the exact desiredtunnel placement (you get what you get) - Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. By using this website, you agree to our Arthrosc Tech 5:e189e195, Hofbauer M, Muller B, Murawski CD, Baraga M, van Eck CF, Fu FH (2013) Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction. - makesure that interference screws are less than 25 mm in length; Thomas NP, Kankate R, Wandless F, Pandit H. Am J Sports Med. 1). Patient age and activity level are also important factors when deciding on graft choice for revision procedures. Unauthorized use of these marks is strictly prohibited. Cite this article. Then in that case, yes, I would code this as 29888-52. 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. Comparison of Femoral Tunnel Position and Clinical Results. With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. Two years after the surgery, she resumed all activities and plays collegiate volleyball. One comparative cohort study reported that objective outcomes and subjective patient scores and satisfaction were not significantly different between one-stage and two-stage revision ACLRs and both groups had significantly improved objective outcomes and patient subjective outcomes without notable differences in failure rates [42]. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. PMC Salem HS, Axibal DP, Wolcott ML, et al. Get timely coding industry updates, webinar notices, product discounts and special offers. - Discussion: - this technique allows for a more anatomic and precise placement of the femoral tunnel (more reliable posterior placement); 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. Some authors have described the additional use of CT scans to confirm healing at 35months after bone grafting [4, 12, 33, 34]. proprioceptive reflex leading to a functional extension loss while the patient is awake. Unless you probe for a root tear during surgery, you may miss it. The slope causes the tibia to move forward and the femur to fall backward, putting tremendous strain on the ACL. As our group described in 2013 in American Journal of Sports Medicine, all of these factors contribute to ACL failure and to the success of revision ACL surgery. Mayo Clinic is a not-for-profit organization. doi: 10.1016/j.eats.2020.08.024. Arthrosc Tech. Tibial Tunnel Bone Allograft Cpt Code For The. There is ongoing debate about how best to reconstruct the anterior cruciate ligament (ACL) to restore knee kinematics, including which is the best fixation method. Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. There was also a significant improvement in the Lysholm score when comparing preoperative and postoperative values. Reflex extension loss afteranterior cruciate ligamentreconstruction due to femoral "high noon" graft placement. endobj However, Thomas et al. performed a CT scan at 4months to assess healing of the bone graft in the tibial tunnel. 2020;38:1191. 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]. 1 0 obj An average Lysholm score at 2 years post operation was 96.6 points 2.1 (91100 points). Clin Radiol 68:e552e559, Marchant MH Jr, Willimon SC, Vinson E, Pietrobon R, Garrett WE, Higgins LD (2010) Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction. Two-stage revision anterior cruciate ligament reconstruction, https://doi.org/10.1186/s43019-019-0010-6, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. 2018 Apr-Jun;9(2):116-120. doi: 10.1016/j.jcot.2018.02.010. TJ!!X`Sz9Q*BeV={=F ' 0y^*2| '! 2013;41:1296. 2020 Sep;140(9):1211-1219. doi: 10.1007/s00402-020-03421-7. CPT codes are grouped into 6 sections: 1. eCollection 2021 Dec. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. 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. Tibial tunnel was found to be anterior, perhaps more inferior than would be in an anatomic ACL insertion. Before endstream - over the top repair tensioned in extension will provide support in terminal extension but may slacken at greater flexion angles; For a better experience, please enable JavaScript in your browser before proceeding. 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. To date, the literature on revision ACLR surgery has primarily focused on comparing the outcomes to those of primary ACLR. The same is repeated for the tibial tunnel while providing support for the proximal end of the tunnel. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. I forgot to mention he did an allograft bone graft. Accessibility 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. Hi you mentioned this was a staged procedure - any chance you can post the entire operative report without patient info? 19 Despite favorable outcomes after interference screw fixation, there are concerns related to graft biology, such as graft damage during screw insertion, a small tendon-to-bone contact area for graft integration, the presence of . Bone Incorporation of Silicate-Substituted Calcium Phosphate in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic and Radiographic Study. . Title: Slide 1 Author: Charles H Brown Created Date: 12/3/2018 11:52:05 AM . Am J Sports Med 38:19791986, Dye SF (1996) The future of anterior cruciate ligament restoration. 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. To minimize the risk of viral and bacterial contamination, allograft bone is sterilized. An Observational Study Using Navigated Measurements. sharing sensitive information, make sure youre on a federal Arthroscopic knee procedure CPT codes range from 29866 to 29889. - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. One-Stage ACL Revision Using a Bone Allograft Plug for a Semianatomic Tibial Tunnel That Is Too Anterior. 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.
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