2020 Sep;140(9):1211-1219. doi: 10.1007/s00402-020-03421-7. Spine (Phila Pa 1976) 35:E1058E1063, Lerner T, Liljenqvist U (2013) Silicate-substituted calcium phosphate as a bone graft substitute in surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Am 100:9931000, Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. The metaphyseal location and predominantly cancellous bone surrounding the graft tissue result in high osteoinductive and osteogenic potential from the hosts bone marrow [26]. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. Disclaimer. - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. eCollection 2022 Jun. You are using an out of date browser. (C) Sagittal magnetic resonance imaging showing insufficiency of the anterior cruciate ligament graft. 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 . You must log in or register to reply here. Arthroscopy 33:819827, Diamantopoulos AP, Lorbach O, Paessler HH (2008) Anterior cruciate ligament revision reconstruction: results in 107 patients. Unable to load your collection due to an error, Unable to load your delegates due to an error. To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. The https:// ensures that you are connecting to the Neil Duplantier MD. 2018 Apr-Jun;9(2):116-120. doi: 10.1016/j.jcot.2018.02.010. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. Patients who have lost a meniscus or have a significant cartilage defect and have a failed ACL can, in some circumstances, require a meniscus transplant or cartilage replacement surgery. Samuelsen BT, Webster KE, Johnson NR, Hewett TE, Krych AJ. [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. TJ!!X`Sz9Q*BeV={=F ' 0y^*2| '! I just want to get the basic idea so I can advise him since he keeps a copy of his billing. A new harvest site for bone graft in anterior cruciate ligament revision surgery. 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. Conclusion: National Library of Medicine Mayo Clinic is a not-for-profit organization. 3 0 obj
JavaScript is disabled. 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. -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.. Tunnel malpositioning and widening remain the most common indications for two-stage revision ACLR. Preoperative planning is critical to identify and characterize bone tunnel pathology. 2013;41:1296. Purpose: J Knee Surg 17:127132, Mayr R, Rosenberger R, Agraharam D, Smekal V, El Attal R (2012) Revision anterior cruciate ligament reconstruction: an update. Kim, DH., Bae, KC., Kim, DW. Outcomes of repeat revision anterior cruciate ligament reconstruction. Arthrosc Tech. Her alignment, tibial slope and cartilage were all normal. Ki-Cheor Bae. 2020 Dec 21;9(12):e1917-e1925. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. - over the top repair tensioned in extension will provide support in terminal extension but may slacken at greater flexion angles; The inside punch of the harvester is tapped and this allows delivery of the graft in a controlled manner and its impaction into the tunnel. 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. Numerous studies have reported that additional procedures (e.g., extra-articular tenodesis, anatomical anterolateral ligament (ALL) reconstruction) could be a meaningful option in cases of revision ACLR to improved rotatory stability which is associated with re-injury. I forgot to mention he did an allograft bone graft. 2005 Nov;33(11):1701-9. doi: 10.1177/0363546505276759. Few studies report the outcomes of two-stage revision ACLR alone. One-Stage ACL Revision Using a Bone Allograft Plug for a Semianatomic Tibial Tunnel That Is Too Anterior. Get timely coding industry updates, webinar notices, product discounts and special offers. - Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. 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. CAS Am J Sports Med 40:800807, Article [26] reported the use of a sCO2-sterilized bone allograft to fill tunnel defects as the first stage of a two-stage revision ACLR. 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]. Stage II lateral root tear, lateral root repair and repeat revision back-to-back ACL repair. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. He did other procedures, but I have the codes for them. 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? Clin Sports Med 36:173187, Trojani C, Beaufils P, Burdin G, Bussiere C, Chassaing V, Djian P et al (2012) Revision ACL reconstruction: influence of a lateral tenodesis. Ramp tears can lead to rotational instability and put excessive strain on the ACL graft, causing it to fail. 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). Pre-op imaging shows excessive tunnel and socket widening and no malalignment with normal slope. Anterior cruciate ligament (ACL) reconstruction rates have increased over the past 20years to roughly 200,000 per year [1]. My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. Only 44 patients underwent a staged revision ACLR after bone grafting and 10 patients refused to undergo a revision ACLR. ACL reconstruction is surgery to replace a torn anterior cruciate (KROO-she-ate) ligament (ACL) a major ligament in your knee. 2017 Oct;475(10):2459-2468. doi: 10.1007/s11999-017-5278-9. Two years after the surgery, she resumed all activities and plays collegiate volleyball. With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. %PDF-1.5
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Orthopaedic Specialists of North Carolina. See our privacy policy. For a better experience, please enable JavaScript in your browser before proceeding. Additionally, Brown and Carson [20] regarded patients with a bone tunnel of <15mm diameter as good candidates for grafting. 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. 2022 May 11;11(6):e971-e976. - lateral tunnel placement: 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. 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. They observed that the the failure rate was 10.3% in the one-stage revision group and 6.1% in the two-stage group.
$.' I would look at billing 29877 for the debridement of the soft tissue. performed a CT scan at 4months to assess healing of the bone graft in the tibial tunnel. We routinely obtain hip-to-ankle AP X-rays to assess for any coronal plane malalignment. Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. doi: 10.1016/j.eats.2021.11.019. The goal of revision ACLR is to improve knee stability and activity levels, but the outcomes are reported to be inferior to those of primary ACLR [3]. 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. 2021 Nov 16;10(12):e2699-e2708. A tamp is used to further compress the graft. Drilling a tibial tunnel at 40 degrees yields an average tunnel length of 45.442.18 mm. 6 0 obj
Not applicable, this is a review article. Bookshelf 2015;43:2510. Reports suggest that a two-stage procedure is performed in only 8 to 9% of revision ACLRs [6]. eCollection 2022 Mar. A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction. Arch Orthop Trauma Surg. One of the main factors associated with tunnel enlargement is malposition of the tibial tunnel, which likely leads to graft micromotion. Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. The bone graft is deployed, and plunger can be used to gently pack graft into tunnel. Am J Sports Med 47:324333, Chmielewski TL, Hurd WJ, Rudolph KS, Axe MJ, Snyder-Mackler L (2005) Perturbation training improves knee kinematics and reduces muscle co-contraction after complete unilateral anterior cruciate ligament rupture. In 4 studies, the authors reported the time interval between first and second surgeries, with an average of 6.1 months for ICBG compared with 8.7 months for allogenic and synthetic grafts. Results: At Mayo Clinic, we sometimes correct the alignment before performing revision ACL surgery, to prevent graft failure. 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. proprioceptive reflex leading to a functional extension loss while the patient is awake. Epub 2005 Aug 10. Punch-biopsy specimens of the augmented tunnels were taken at the two-stage procedure, and histologic examination included quantitative analysis of the area of immature bone formation, lamellar bone, and bone marrow. The prior skin incision is typically used to expose the distal portion of the tibial tunnel. In the immediate postoperative period, the weakest part of any ACLR is the fixation. At a mean follow-up of 7.9years, clinical scores following revision ACLR did not differ significantly according to the tunnel size. Louis et al. American Journal of Sports Medicine. doi: 10.1016/j.eats.2022.01.004. This site needs JavaScript to work properly. Secure graft fixation is critical in ensuring a successful two-staged ACLR. Inferior tendon graft to bone tunnel healing at the tibia compared to that at the femur after anterior cruciate ligament reconstruction. Please enable it to take advantage of the complete set of features! - graft was placed on the femoral site in the high noon position combined with a slight medial tibial tunnel placement;