A 17-year-old female came to see us after two failed ACL surgeries. We focus on many factors including the status of the menisci, cartilage, alignment, tibial slope and other knee ligaments, as well as technical issues from the index surgery, such as the positioning of ACL sockets and tunnels. Franceschi F, Papalia R, Di Martino A, Rizzello G, Allaire R, Denaro V. Arthroscopy. 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. 2017 Jun;99-B(6):714-723. doi: 10.1302/0301-620X.99B6.BJJ-2016-0929.R2. Some authors suggest that an accelerated rehabilitation program for revision ACLR is not appropriate because of weaker initial graft fixation [20]. Background: Ligament reconstruction is a common procedure in orthopedic surgery. 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. Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. Tunnel malpositioning and widening remain the most common indications for two-stage revision ACLR. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. You are using an out of date browser. - consider whether there is an interplay between posterior graft placement and appropriate graft tension; Before Aust N Z J Surg 69:517521, Eagan MJ, McAllister DR (2009) Biology of allograft incorporation. Federal government websites often end in .gov or .mil. - 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; stream It may not display this or other websites correctly. PMC Two-stage revision anterior cruciate ligament reconstruction. With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. [38] have reported the outcomes of revision ACLR with and without lateral extra-articular tenodesis. Tibial tunnel was found to be anterior, perhaps more inferior than would be in an anatomic ACL insertion. - A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction But no significant difference was observed between the two groups. Tibial Tunnel Bone Allograft Cpt Code For The. a meta-analysis of 32 studies. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. However, many authors prefer using an autograft for revision ACLR when possible. The optimal and earliest possible timing of the two-stage procedure is still not clear. 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. https://doi.org/10.1186/s43019-019-0010-6, DOI: https://doi.org/10.1186/s43019-019-0010-6. 2003 Jan;34(1):49-64. doi: 10.1016/s0030-5898(02)00070-6. - open technique(which might be required with arthroscopy malfunction). The https:// ensures that you are connecting to the eCollection 2021 Oct-Dec. von Recum J, Schwaab J, Guehring T, Grtzner PA, Schnetzke M. Arthroscopy. It is commonly injured during high-intensity sports. <> endobj 2022 Jun 21;11(7):e1367-e1372. A clinical, prospective, randomized, double-blind study, Femoral Shaft Frx: Leg Lengths / Nail Lengths, Orthopaedic Specialists of North Carolina. 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. ACL graft can replicate the normal ligament's tension curve. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. doi: 10.2106/JBJS.ST.20.00055. MARS Group. <> Part of 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. The prior skin incision is typically used to expose the distal portion of the tibial tunnel. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. statement and Hi you mentioned this was a staged procedure - any chance you can post the entire operative report without patient info? 2022 Feb 28;11(3):e463-e469. Privacy Is it appropriate to assign codes for both the arthroscopic and open portions of the procedure? doi: 10.1016/j.eats.2020.08.024. 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 2005 Aug 10. 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. Not applicable, this is a review article. In 2 studies, the authors investigated the outcomes of allograft: allograft bone matrix (ABM) and allograft bone chips (AC). 2002 Richard O'Connor Award paper. - 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. Resurfacing technique consisting of transplantation of multiple osteochondral grafts to smooth the area. 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. 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). A clinical, prospective, randomized, double-blind study. endobj - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 960 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The https:// ensures that you are connecting to the Patrick C. McCulloch MD. Spine J 7:475490, Jenis LG, Banco RJ (2010) Efficacy of silicate-substituted calcium phosphate ceramic in posterolateral instrumented lumbar fusion. An active infection should be treated with irrigation and debridement with confirmation of eradication (e.g., normalized laboratory test results, negative cultures) before a patient has a new graft and implant put in place. Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. - Surgical Technique: - Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. At Mayo Clinic, we have the imaging, surgical and physical therapy teams to manage extremely complex knee issues. Recently, we recognized that patients needing ACL reconstruction who also have significant rotatory instability of the knee may have injuries in the anterolateral complex. 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]. - tunnel positioning: 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 Unauthorized use of these marks is strictly prohibited. Stage II lateral root tear, lateral root repair and repeat revision back-to-back ACL repair. Evaluations were performed in the axial plane of the tibia using three parameters (occupying ratio, union ratio, and bone mineral density). 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. 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). Am J Sports Med. They are benign ganglion cysts that develop in or around the osseous tibial tunnel made during ACL reconstruction using the transtibial technique 1-2. In cases like these your going to need to bill out "what you can" which in this case would be 20680. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. Failed ACL with Tunnel Enlargement: How I Bone Graft & Stage It Charles H. Brown Jr.,MD Director Abu Dhabi, United Arab Emirates . Phys Ther 85:740749, PubMed For a better experience, please enable JavaScript in your browser before proceeding. 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. 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. 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. 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. official website and that any information you provide is encrypted Trojani et al. CT scans to confirm healing at 3-5months after bone grafting [4, 12, 33, 34]. Data Trace is the publisher of Two-stage revision ACLR should be considered in cases of tunnel lysis, infection, malalignment, meniscal deficiency, or chondral lesions. Purpose: 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. Si-CaP appears to provide a more stable osteoconductive scaffold to support faster angiogenesis. Cancel anytime. American Journal of Sports Medicine. Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. 2013;41:1296. 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]. femoral tunnel too far anterior in the notch; Thomas et al. TECHNIQUE VIDEO. 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. <> 1). A common belief of having 20mm of grafts within the femoral tunnel is backed mostly by hearsay rather than scientific proof. Bookshelf Uchida et al. et al. JavaScript is disabled. Increasing expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions require precise knowledge of technical details such as minimum intra-femoral tunnel graft lengths. - Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. Yoon et al. You are using an out of date browser. Manage cookies/Do not sell my data we use in the preference centre. This process is repeated until there is full fill of femoral tunnel. The femoral tunnel was a little high. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. Silicate-substituted calcium phosphate (Si-CaP), which represents a synthetic, porous bone-graft substitute, may also be an appropriate bone-graft substitute [27,28,29,30]. Unable to load your collection due to an error, Unable to load your delegates due to an error. - Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position . He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. This site needs JavaScript to work properly. - historic techniques: J Bone Joint Surg Am 100:9931000, Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. 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. 8 Therefore, one should avoid angles <40 to 45 . - Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. - anterior graft placement (relative to normal anatomical insertion of ACL) results in high strain on graft as knee is flexed; Your going to need to get very familiar with 2017 CMS NCCI Surgical Policy Manual. At a mean follow-up of 7.9years, clinical scores following revision ACLR did not differ significantly according to the tunnel size. registered for member area and forum access. Thomas et al. Arthrosc Tech. Hello, our physician bone grafted the previous ACL tunnels with allograft via arthroscopy. An Observational Study Using Navigated Measurements and transmitted securely. 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]. Would you like email updates of new search results? 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]. 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. Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? Hello, our physician bone grafted the previous ACL tunnels with allograft via arthroscopy. Houston Methodist Orthopedics & Sports Medicine. 2020 Dec 21;9(12):e1917-e1925. Then in that case, yes, I would code this as 29888-52. Orthopaedic Specialists of North Carolina. Get timely coding industry updates, webinar notices, product discounts and special offers. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Primary ACL reconstruction is recognized as a successful procedure, but failure has been shown to occur in approximately 10% of patients. FOIA 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). - Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study doi: 10.1016/j.eats.2020.08.024. Study design: Keep your critical coding and billing tools with you no matter where you work. registered for member area and forum access. 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. You must log in or register to reply here. [31] used Si-CaP for a bone-graft substitute for tunnel augmentation in two-stage revision ACLR. Excessive tibial slope also puts patients at much higher risk of early ACL reconstruction failure. Epub 2007 Jan 5. This content does not have an Arabic version. Bone tunnel-related issues are frequently encountered during revision anterior cruciate ligament reconstruction. registered for member area and forum access. Bone Graft related CPT Codes. The patients were divided into two groups based on the tunnel diameter (group A, <12mm; group B, <12mm). anterior cruciate ligament; bone graft; knee; revision. 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. The analysis included 7 studies with a total of 234 patients. Arthroscopic Revision of Attenuated Anterior Cruciate Ligament Graft With Enlarged Bone Tunnels Using Injectable Bone Graft Substitute. With each added degree of inclination, one gains 0.68 mm of tibial tunnel length. 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. [43] reported the results of 54 patients who underwent bone grafting due to recurrent, symptomatic ACL deficiency following ACLR. 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. Provided by the Springer Nature SharedIt content-sharing initiative. doi: 10.1016/j.eats.2022.01.004. View all the articles associated with any code, right from the code page. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. The .gov means its official. Arch Orthop Trauma Surg. A decision that will often depend on the graft used during the primary ACLR. Two years after the surgery, she resumed all activities and plays collegiate volleyball. - posterior placement or distal to normal site of attachment results in excessive tightening of the graft when knee is extended; Springer Nature. 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. - lateral tunnel placement: 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. Previous literature has reported that if the tunnel size exceeds 1015mm, two-stage surgery should be performed. Biomaterials 27:50145026, Hing KA, Wilson LF, Buckland T (2007) Comparative performance of three ceramic bone graft substitutes. 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 Careers. Careers. My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. Knee Surg & Relat Res 31, 10 (2019). The surgeon submitted CPT code 25431 alone. 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 . These lesions are often difficult to see on MRI. Conclusion: Bone Grafting Tibial and Femoral Tunnels knee Portion of op note reads as follows: ACL was completely absent in mid aspect. Bone Grafting Technique in Revision ACL Reconstruction: Coring Reamer and Dowel Trick. - Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. Example: 29888 - ACL Repair G0289 - Arthroscopy, knee, surgical, for removal of loose body, Harvesting and inserting the graft is included in code . One of the main factors associated with tunnel enlargement is malposition of the tibial tunnel, which likely leads to graft micromotion. TJ!!X`Sz9Q*BeV={=F ' 0y^*2| '! 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]. He is only grafting the bone. 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. 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. 2021 Oct 12;11(4):e20.00055. 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. Few studies report the outcomes of two-stage revision ACLR alone. The site is secure. Sorry. 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. Thomas NP, Kankate R, Wandless F, Pandit H. Am J Sports Med. 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. Epub 2018 Feb 23. Approximately 200,000 anterior cruciate ligament (ACL) ruptures occur in the United States annually. FOIA - Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation This site needs JavaScript to work properly. At Mayo Clinic, we frequently perform osteotomies to correct both sagittal plane and coronal plane deformity. 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. The indication for bone grafting and between-stage protocol varied among studies. Outcomes of repeat revision anterior cruciate ligament reconstruction. Our Experience: 2014 - 2018 . Study design: Systematic review. Orthopedics 39:e456e464, Noyes FR, Barber-Westin SD (2006) Anterior cruciate ligament revision reconstruction: results using a quadriceps tendon-patellar bone autograft. We NEVER sell or give your information to anyone. 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. CT examinations were performed at 3, 12, and 24weeks after bone grafting. You are using an out of date browser. Patients who underwent ACL reconstruction (Current Procedural Terminology (CPT) code 29888) between 20 were identified using the PearlDiver database. I forgot to mention he did an allograft bone graft. - anteromedial portal technique: - one incision transtibialtechnique By using this website, you agree to our HHS Vulnerability Disclosure, Help Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. No charge. 2015;43:2510. When performing a revision reconstruction, the surgeon decides between a single-stage or a two-stage revision. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. Autograft bone, either from the iliac crest or anterior tibial plateau, is still considered the gold standard source for grafting because of its osteoconductive, osteoinductive, and osteogenic properties. 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? This site complies with the HONcode standard for trustworthy health information: verify here. We routinely obtain hip-to-ankle AP X-rays to assess for any coronal plane malalignment. He did other procedures, but I have the codes for them. Unable to load your collection due to an error, Unable to load your delegates due to an error. Bone Incorporation of Silicate-Substituted Calcium Phosphate in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic and Radiographic Study. 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%). - over the top repair tensioned in extension will provide support in terminal extension but may slacken at greater flexion angles; - ACL position is lower and more horizontal than that achieved when performing the transtibial (TT) procedure. Philippe C, Marot V, Courtot L, Mesnier T, Reina N, Cavaignac E. Arthrosc Tech. A Retrospective Comparative Study. - with a posteriorly positioned femoral tunnel consider final tibial graft fixation in full extension ratherthan 30 deg flexion, since positioning . ]+yC`6Hd Ql]M 3w7ah;HNdyS*7x-zq^/4%^6eA$m@(,ly}U[N9E(/=iHCL")d6yx]K7!84,q!r~#6mE8dIS69eYn 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. - Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction? Correlation between femoral tunnel length and tunnel position in ACL reconstruction. Meniscal tears are another contributing cause. Mayo Clinic is a not-for-profit organization. [33] evaluated 30 patients who underwent two-staged ACLR revision procedure after a traumatic re-rupture of the ACL. Patient age and activity level are also important factors when deciding on graft choice for revision procedures. and transmitted securely. Finally, 1 study compared ICBG to a synthetic bone substitute. Arthrosc Tech. However, with precise indications, proper preoperative planning and operative-technique selection, two-stage revision ACLR can achieve favorable outcomes. 2017 Oct;475(10):2459-2468. doi: 10.1007/s11999-017-5278-9. Rehabilitation after the initial bone-grafting stage shares similarities with standard ACLR protocols [17]. endobj Grassi A, Nitri M, Moulton SG, Marcheggiani Muccioli GM, Bondi A, Romagnoli M, Zaffagnini S. Bone Joint J. 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. 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. 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).

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