<> Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. [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. An Observational Study Using Navigated Measurements. Philippe C, Marot V, Courtot L, Mesnier T, Reina N, Cavaignac E. Arthrosc Tech. Cite this article. 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. 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. 2007 May;23(5):558.e1-4. 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 . JavaScript is disabled. J Knee Surg 17:127132, Mayr R, Rosenberger R, Agraharam D, Smekal V, El Attal R (2012) Revision anterior cruciate ligament reconstruction: an update. 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. 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. These lesions are often difficult to see on MRI. Previous literature has reported that if the tunnel size exceeds 1015mm, two-stage surgery should be performed. Telephone: 410.494.4994, Morphology of the Femoral Intercondylar Notch, The Lateral Intercondylar RidgeA Key to Anatomic Anterior Cruciate Ligament Reconstruction. This content does not have an Arabic version. A single copy of these materials may be reprinted for noncommercial personal use only. 8600 Rockville Pike Then in that case, yes, I would code this as 29888-52. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. Uchida et al. - this restricts flexion of knee if graft remains intact, or it may elongate graft if the range of motion is restored; 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%). MeSH 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. 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]. Knee Surgery & Related Research Stage II lateral root tear, lateral root repair and repeat revision back-to-back ACL repair. However, many authors prefer using an autograft for revision ACLR when possible. - references: ",#(7),01444'9=82. Unable to load your collection due to an error, Unable to load your delegates due to an error. [21] evaluated 88 patients who underwent one-stage revision ACLR. Houston Methodist Orthopedics & Sports Medicine. Trojani et al. FOIA Tibial Tunnel Bone Allograft Cpt Code For The. I just want to get the basic idea so I can advise him since he keeps a copy of his billing. et al. Stage I femoral and tibial bone grafting. BMC Musculoskelet Disord 19:246. In addition, patients who receive revision ACL surgery might have other damaged ligaments. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. doi: 10.1016/j.eats.2021.11.019. Bone Grafting Technique in Revision ACL Reconstruction: Coring Reamer and Dowel Trick. J Bone Joint Surg Br 89:10511054, Article Unauthorized use of these marks is strictly prohibited. Clin Sports Med 18:109171, Yoon KH, Kim JS, Park SY, Park SE (2018) One-stage revision anterior cruciate ligament reconstruction: results according to preoperative bone tunnel diameter: five to fifteen-year follow-up. - 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. When measuring with CT, the axial-plane image is considered incorrect because the plane of cuts is inconsistent. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Revision ACL surgery: A comprehensive approach. JFIF C Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. 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. 2020 Sep;140(9):1211-1219. doi: 10.1007/s00402-020-03421-7. Measurements are made perpendicular to the axial plane of the tunnel at the widest point [15]. However, the small number of included patients, especially in the group of patients without revision ACLR, is limited. Predictors of clinical outcome following revision anterior cruciate ligament reconstruction. Reflex extension loss afteranterior cruciate ligamentreconstruction due to femoral "high noon" graft placement. 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. Excessive tibial slope also puts patients at much higher risk of early ACL reconstruction failure. Part of <> doi: 10.1016/j.eats.2022.01.004. Although there are many proposed theories for tunnel lysis, it is most accurate to state that this condition has a multifactorial origin; mechanical and biologic causes have been reported, and both contribute to enlarged graft tunnels [11, 13]. CT examinations were performed at 3, 12, and 24weeks after bone grafting. A 17-year-old female came to see us after two failed ACL surgeries. Anterior cruciate ligament reconstruction with patellar tendon: an ex vivo study of wear-related damage and failure at the femoral tunnel, Anterior cruciate ligament replacements: a mechanical study of femoral attachment location, flexion angle at tensioning, and initial tension, Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? Anterior cruciate ligament (ACL) reconstruction rates have increased over the past 20years to roughly 200,000 per year [1]. Unable to load your collection due to an error, Unable to load your delegates due to an error. - anteromedial portal technique: Bruce A. - Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. - makesure that interference screws are less than 25 mm in length; You must log in or register to reply here. - ACL position is lower and more horizontal than that achieved when performing the transtibial (TT) procedure. A Meta-analysis of 47,613 Patients. However, with precise indications, proper preoperative planning and operative-technique selection, two-stage revision ACLR can achieve favorable outcomes. This adds a fair amount of complexity to the procedure. We routinely obtain hip-to-ankle AP X-rays to assess for any coronal plane malalignment. TECHNIQUE STEPS. A new harvest site for bone graft in anterior cruciate ligament revision surgery. 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. Correspondence to The AHA Coding Clinic for HCPCS includes: Thank you for choosing Find-A-Code, please Sign In to remove ads. A tamp is used to further compress the graft. - two incision technique (outside in) With each added degree of inclination, one gains 0.68 mm of tibial tunnel length. statement and 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 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 The bone grafting is an opportune time to do an osteotomy to correct the malalignment. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. - Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. I would look at billing 29877 for the debridement of the soft tissue. 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. Journal of Orthopaedic Research. What other specialized procedures might be performed in conjunction with ACL revision surgery? official website and that any information you provide is encrypted Therefore, the coronal and sagittal images (four-tunnel view; femur-coronal, tibia-coronal, femur-sagittal, tibia-sagittal) are primarily used (Fig. Mayo Clinic sports medicine surgeons routinely perform revision surgery for patients who have undergone one or more ACL reconstructions elsewhere, and have published extensively on this topic. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. To read the full article, sign in and subscribe to the AHA Coding Clinic for HCPCS. endobj Salem HS, Axibal DP, Wolcott ML, et al. anterior cruciate ligament; bone graft; knee; revision. Additionally, graft-tunnel mismatch is problematic, often leading to inadequate osseous . Autograft was used in 4 studies: iliac crest bone autograft (ICBG, n = 3) and tibial bone autograft (TBA, n = 1). In active young patients, failed primary ACLR may require a revision ACLR. - Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study Is it appropriate to assign codes for both the arthroscopic and open portions of the procedure? 2. - this represents the closest reconstitution of the ACL's "physiometry"; (see: isometry); Towson, MD 21204 The two-stage group contained significantly more patients with meniscal and chondral pathology compared with the primary ACLR group. doi: 10.1016/j.eats.2020.08.024. - Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. At a mean follow-up of 7.9years, clinical scores following revision ACLR did not differ significantly according to the tunnel size. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. PMC Am J Sports Med 38:19791986, Dye SF (1996) The future of anterior cruciate ligament restoration. Because of weak bone from bone-grafted tunnels or enlarged tunnels, the surgeons should pay careful attention to the fixation methods and consider double fixation in all revisions [37]. 4. Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. - anterior graft placement (relative to normal anatomical insertion of ACL) results in high strain on graft as knee is flexed; 2002 Richard O'Connor Award paper. - under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a Two-stage revision anterior cruciate ligament reconstruction: a systematic review of bone graft options for tunnel augmentation. 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. 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. At Mayo Clinic, we frequently perform osteotomies to correct both sagittal plane and coronal plane deformity. Epub 2018 Dec 17. The new ligament was fixed to the tibia by a metallic screw and to the femur by a bioabsorbable screw. 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]. Not applicable, this is a review article. eCollection 2022 Jun. One of the main factors associated with tunnel enlargement is malposition of the tibial tunnel, which likely leads to graft micromotion. 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. Epub 2018 Dec 17. endstream If this is your first visit, be sure to check out the. - lateral tunnel placement: Accessibility eCollection 2022 Mar. Rehabilitation after the initial bone-grafting stage shares similarities with standard ACLR protocols [17]. There are several procedures that can be performed in the ACL revision setting, such as anterolateral ligament reconstruction and iliotibial band tenodesis, to control that rotation. endobj Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Clipboard, Search History, and several other advanced features are temporarily unavailable. The tibial tunnel looked to be in a good position. The surgeon submitted CPT code 25431 alone. A new and innovative procedure. Comparison of Femoral Tunnel Position and Clinical Results. 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).