The use of allograft material negates the issue of donor-site morbidity but carries the potential risk of disease or infection transmission [23, 24]. - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. doi: 10.1016/j.eats.2022.03.024. [21] evaluated 88 patients who underwent one-stage revision ACLR. MeSH Bruce A. Grassi A, Nitri M, Moulton SG, Marcheggiani Muccioli GM, Bondi A, Romagnoli M, Zaffagnini S. Bone Joint J. Thomas NP, Kankate R, Wandless F, Pandit H. Am J Sports Med. However, Thomas et al. ACL reconstruction - Mayo Clinic - Mayo Clinic - Mayo Clinic 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? Biomechanical Comparison Between Bashti Bone Plug Technique and Knee 23:830836, MARS Group (2014) Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the Multicenter ACL Revision Study (MARS) Cohort. Knee-laxity measurements were elevated in the without-revision group, but the difference was not significant. The analysis included 7 studies with a total of 234 patients. Epub 2020 Apr 1. 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. Similarly, root tears of the lateral meniscus are often missed as well. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 960 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 2002 Richard O'Connor Award paper. 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. All rights reserved. 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. Arthrosc Tech. Am J Sports Med 38:19791986, Dye SF (1996) The future of anterior cruciate ligament restoration. 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]. Bethesda, MD 20894, Web Policies Biazzo A, Manzotti A, Motavalli K, Confalonieri N. J Clin Orthop Trauma. #1. Arthrosc Tech. 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. 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/. The surgeon submitted CPT code 25431 alone. Revision ACL surgery: A comprehensive approach. They observed that the the failure rate was 10.3% in the one-stage revision group and 6.1% in the two-stage group. 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. Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. 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. I am still awaiting the OP note from the ASC, which takes weeks, so I can't post it. A two-stage procedure is technically more demanding than the primary or one-stage procedure and outcomes are potentially inferior, especially for active patients who make a high demand on their bodies. Background: Ligament reconstruction is a common procedure in orthopedic surgery. Uchida et al. [31] used Si-CaP for a bone-graft substitute for tunnel augmentation in two-stage revision ACLR. Revision ACL surgery: A comprehensive approach - Mayo Clinic The bone graft is deployed, and plunger can be used to gently pack graft into tunnel. - ACL graft should pull up intotibial tunnel by about 2mm with extension when fixed on femoral side; 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]. Data Trace is the publisher of Careers. Drilling the Femoral Tunnel During ACL Reconstruction: Transtibial Versus Anteromedial Portal Techniques. Clipboard, Search History, and several other advanced features are temporarily unavailable. The slope causes the tibia to move forward and the femur to fall backward, putting tremendous strain on the ACL. If this is your first visit, be sure to check out the. Femoral Tunnel for ACL Reconstruction - Wheeless' Textbook of Orthopaedics Guide pins were placed in the tibial tunnel and next putty and dowels (grafts) were placed in the tibial and femoral tunnels. JavaScript is disabled. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. 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. Journal of Orthopaedic Research. Additionally, graft-tunnel mismatch is problematic, often leading to inadequate osseous . Keywords: Patients who underwent ACL reconstruction (Current Procedural Terminology (CPT) code 29888) between 20 were identified using the PearlDiver database. Reflex extension loss afteranterior cruciate ligamentreconstruction due to femoral "high noon" graft placement. At Mayo Clinic, we sometimes correct the alignment before performing revision ACL surgery, to prevent graft failure. Ramp tears can lead to rotational instability and put excessive strain on the ACL graft, causing it to fail. 5 0 obj Purpose: Therefore, the coronal and sagittal images (four-tunnel view; femur-coronal, tibia-coronal, femur-sagittal, tibia-sagittal) are primarily used (Fig. 2015;43:2510. Additionally, Brown and Carson [20] regarded patients with a bone tunnel of <15mm diameter as good candidates for grafting. Towson, MD 21204 [33] evaluated 30 patients who underwent two-staged ACLR revision procedure after a traumatic re-rupture of the ACL. - ref: Correlation between femoral tunnel length and tunnel position in ACL 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]. endobj - Reflex extension loss afteranterior cruciate ligamentreconstruction due to femoral "high noon" graft placement. Phys Ther 85:740749, PubMed Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up. Before Louis et al. 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. Orthopedics 39:e456e464, Noyes FR, Barber-Westin SD (2006) Anterior cruciate ligament revision reconstruction: results using a quadriceps tendon-patellar bone autograft. [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 . Philippe C, Marot V, Courtot L, Mesnier T, Reina N, Cavaignac E. Arthrosc Tech. - figure four flexedpositionassist with providing the best femoral target; ]+yC`6Hd Ql]M 3w7ah;HNdyS*7x-zq^/4%^6eA$m@(,ly}U[N9E(/=iHCL")d6yx]K7!84,q!r~#6mE8dIS69eYn Preoperative Patient Care. - w/a right knee, place the tunnel at about the 9:30 to 10 oclock position; - this represents the closest reconstitution of the ACL's "physiometry"; (see: isometry); - Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction? The authors declare that they have no competing interests. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. - Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. 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]. Preoperative planning is critical to identify and characterize bone tunnel pathology. A tamp is used to further compress the graft. [38] have reported the outcomes of revision ACLR with and without lateral extra-articular tenodesis. Franceschi F, Papalia R, Di Martino A, Rizzello G, Allaire R, Denaro V. Arthroscopy. Bone Graft related CPT Codes. - one incision transtibialtechnique 2002 Richard O'Connor Award paper. Consistent Indications and Good Outcomes Despite High Variability in An Observational Study Using Navigated Measurements Arthroscopic Delivery of Injectable Bone Graft for Staged Revision Tibial Tunnel Bone Allograft Cpt - toyoulalar 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]. 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. These lesions are often difficult to see on MRI. 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. Graft-Tunnel Mismatch in Bone-Tendon-Bone ACL Reconstruction - LWW See our privacy policy. I forgot to mention he did an allograft bone graft. One-Stage ACL Revision Using a Bone Allograft Plug for a Semianatomic Tibial Tunnel That Is Too Anterior. 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. Arch Orthop Trauma Surg. Bone graft substitute for tunnel filling improved ACL reconstruction Unable to load your collection due to an error, Unable to load your delegates due to an error. Arthroscopy 21:767, Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. 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. The .gov means its official. 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]. Arthroscopic Delivery of Injectable Bone Graft for Staged Revision You must log in or register to reply here. Yoon et al. Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A 8600 Rockville Pike This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. CPT codes are grouped into 6 sections: 1. Salem HS, Axibal DP, Wolcott ML, et al. Sometimes we can perform a biplanar osteotomy to correct both planes of deformity at once. PDF Two-stage revision anterior cruciate ligament reconstruction Am J Sports Med. (A, B) Anteroposterior and lateral knee radiographs showing bone tunnel positioning, widening, and retained biocomposite screw. 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]. 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. However, many authors prefer using an autograft for revision ACLR when possible. doi: 10.1016/j.eats.2021.08.013. Reports suggest that a two-stage procedure is performed in only 8 to 9% of revision ACLRs [6]. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. American Journal of Sports Medicine. Study design: Systematic review. 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. [34] reported 10 consecutive patients (four female and six male patients with a mean age of 28years) who underwent autogenous bone grafting prior to ACLR revision. Accessibility - ref: Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. "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. Two years after the surgery, she resumed all activities and plays collegiate volleyball. Keep your critical coding and billing tools with you no matter where you work. 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. Griffith TB, et al. The bone grafting is an opportune time to do an osteotomy to correct the malalignment. 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. 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. - Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. Make a donation. - A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction Purpose: To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. 2022 Feb 28;11(3):e463-e469. Lee et al. Our Experience: 2014 - 2018 . Provided by the Springer Nature SharedIt content-sharing initiative. Mayo Clinic is a not-for-profit organization. Am J Sports Med 45:17901798, Diermeier T, Herbst E, Braun S, Saracuz E, Voss A, Imhoff AB et al (2018) Outcomes after bone grafting in patients with and without ACL revision surgery: a retrospective study. 1 0 obj 110 West Rd., Suite 227 This site needs JavaScript to work properly. - anteromedial portal technique: 2007 May;23(5):558.e1-4. Bone Grafting Tibial and Femoral Tunnels knee Portion of op note reads as follows: ACL was completely absent in mid aspect. Would you like email updates of new search results? 2022 May 11;11(6):e971-e976. J Bone Joint Surg Am 100:9931000, Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. Federal government websites often end in .gov or .mil. BMC Musculoskelet Disord 19:246. 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. Battaglia and Miller [12] indicated that bone grafting should be performed in cases with a tunnel diameter of 1015mm. 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. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. <> 2021 Oct 12;11(4):e20.00055. Aust N Z J Surg 69:517521, Eagan MJ, McAllister DR (2009) Biology of allograft incorporation. A relatively small but challenging subset of patients requires two-stage revision ACLR. 2020 Dec 21;9(12):e1917-e1925. Some authors suggest that an accelerated rehabilitation program for revision ACLR is not appropriate because of weaker initial graft fixation [20]. Conclusion: eCollection 2021 Oct-Dec. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. - The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint Anterior cruciate ligament (ACL) reconstruction remains the gold-standard treatment for young active patients with functional instability after an ACL injury. Mayo Clinic has vast experience treating posterior cruciate ligament, lateral collateral ligament, posterolateral and posteromedial corner injuries, as well as medial collateral ligament injuries. J Knee Surg 17:127132, Mayr R, Rosenberger R, Agraharam D, Smekal V, El Attal R (2012) Revision anterior cruciate ligament reconstruction: an update. ",#(7),01444'9=82. Mosaicplasty. Few studies report the outcomes of two-stage revision ACLR alone. 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]. One of the main factors associated with tunnel enlargement is malposition of the tibial tunnel, which likely leads to graft micromotion. - Drilling the Femoral Tunnel During ACL Reconstruction: Transtibial Versus Anteromedial Portal Techniques. stream Two-stage revision anterior cruciate ligament reconstruction J Bone Joint Surg Br 89:10511054, Article 8600 Rockville Pike ACL Reconstruction - BTB Graft. Arthrosc Tech. Federal government websites often end in .gov or .mil. But an iliac-crest autograft is comparatively invasive with relatively high donor-site morbidity and the potential for insufficient yield quantities [11, 22]. stream 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. 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. 2 0 obj American Journal of Sports Medicine. Predictors of clinical outcome following revision anterior cruciate ligament reconstruction. 4 0 obj Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. The femoral tunnel was a little high. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. Knee Surg Sports Traumatol Arthrosc 20:15651570, Louis ML, D'Ingrado P, Ehkirch FP, Bertiaux S, Colombet P, Sonnery-Cottet B et al (2017) Combined intra- and extra-articular grafting for revision ACL reconstruction: a multicentre study by the French Arthroscopy Society (SFA).
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