One-Stage ACL Revision Using a Bone Allograft Plug for a Semianatomic Tibial Tunnel That Is Too Anterior. A new harvest site for bone graft in anterior cruciate ligament revision surgery. -main criticism is that in some cases a transtibial tunnel will not allow for the exact desiredtunnel placement (you get what you get) Physical therapy with muscle-strengthening and proprioceptive training can be performed. 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]. This provides a cylindrical graft, which is delivered to the femoral tunnel through the arthroscopic portal. The bone graft is deployed, and plunger can be used to gently pack graft into tunnel. 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 - grafts that pass thru femoral tunnels develop more internal pressure at femoral attachment site than those passed over top because of sharp edge of the tunnel; 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. 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).
Overview. Autograft was used in 4 studies: iliac crest bone autograft (ICBG, n = 3) and tibial bone autograft (TBA, n = 1).
JCM | Free Full-Text | Femoral Tunnel Position Affects Postoperative stream
8600 Rockville Pike They recommended that two-stage reconstruction could be safely performed at 24weeks after bone grafting by the iliac-bone block-grafting technique. However, remarkable advances in knowledge of this process have been made based primarly on animal models. However, Thomas et al. CAS Accessibility Allograft bone grafting femoral an Tibial Tunnels, with Debridement of Tunnels The previous ACL graft was debrided with the use of a shaver. He is only grafting the bone. Telephone: 410.494.4994, Morphology of the Femoral Intercondylar Notch, The Lateral Intercondylar RidgeA Key to Anatomic Anterior Cruciate Ligament Reconstruction. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. 2022 May 11;11(6):e971-e976. 2020;38:1191.
Arthroscopic Delivery of Injectable Bone Graft for Staged Revision 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.
Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. 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. 2002 Richard O'Connor Award paper. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. ACL Reconstruction - BTB Graft. endobj
Preoperative Patient Care. - one incision transtibialtechnique Spine (Phila Pa 1976) 20:10551060, Campbell DG, Li P (1999) Sterilization of HIV with irradiation: relevance to infected bone allografts. The indication for bone grafting and between-stage protocol varied among studies. 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]. 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. Two years after the surgery, she resumed all activities and plays collegiate volleyball.
PDF Two-stage revision anterior cruciate ligament reconstruction A Retrospective Comparative Study eCollection 2020 Dec. 2021 Oct 12;11(4):e20.00055. statement and Learn how to get the most out of your subscription.
Bone Marrow Aspirate Concentrate With Two-Staged-Revision ACL doi: 10.1016/j.eats.2022.03.024. American Journal of Sports Medicine. The prior skin incision is typically used to expose the distal portion of the tibial tunnel. 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). 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? View all the articles associated with any code, right from the code page. Cancel anytime. Accessibility 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 I femoral and tibial bone grafting. - Surgical Technique: Her alignment, tibial slope and cartilage were all normal. Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. At Mayo Clinic, we frequently perform osteotomies to correct both sagittal plane and coronal plane deformity. An Observational Study Using Navigated Measurements Measurements are made perpendicular to the axial plane of the tunnel at the widest point. -Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. 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. - Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. While one-stage revision ACLR is well described and reported, few studies have reported the outcomes of two-stage revision ACLR. Arthroscopy 33:819827, Diamantopoulos AP, Lorbach O, Paessler HH (2008) Anterior cruciate ligament revision reconstruction: results in 107 patients. But an iliac-crest autograft is comparatively invasive with relatively high donor-site morbidity and the potential for insufficient yield quantities [11, 22]. 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. We routinely obtain hip-to-ankle AP X-rays to assess for any coronal plane malalignment. Radiographic evaluation of bone graft integration after the first stage was reported in 4 studies, with an average duration of 4.9 months. The AHA Coding Clinic for HCPCS includes: Thank you for choosing Find-A-Code, please Sign In to remove ads. No charge. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. HHS Vulnerability Disclosure, Help - figure four flexedpositionassist with providing the best femoral target; A total 75 patients (75 knees) who underwent ACL reconstruction with tibialis anterior allografts were investigated between February 2015 and October . Then in that case, yes, I would code this as 29888-52. eCollection 2021 Oct-Dec. von Recum J, Schwaab J, Guehring T, Grtzner PA, Schnetzke M. Arthroscopy. The bone grafting is an opportune time to do an osteotomy to correct the malalignment. registered for member area and forum access. Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? To read the full article, sign in and subscribe to the AHA Coding Clinic for HCPCS. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. Unless you probe for a root tear during surgery, you may miss it. 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 . - Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling a statistical evaluation. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Two-Stage Revision Anterior Cruciate Ligament Reconstruction with Cannulated Allograft Bone Dowels Soaked in Bone Marrow Aspirate Concentrate. 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. Keywords: Federal government websites often end in .gov or .mil. I just want to get the basic idea so I can advise him since he keeps a copy of his billing. et al. I just want to get the basic idea so I can advise him since he keeps a copy of his billing. 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. Epub 2020 Apr 1. Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. Conclusions. 2013;41:1296. Clin Orthop Relat Res 474:827835, Van de Pol GJ, Bonar F, Salmon LJ, Roe JP, Pinczewski LA (2018) Supercritical carbon dioxide-sterilized bone allograft in the treatment of tunnel defects in 2-stage revision anterior cruciate ligament reconstruction: a histologic evaluation. 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. Tunnel malpositioning and widening remain the most common indications for two-stage revision ACLR. There has been a long-standing debate as to whether an autograft or an allograft should be used for revision ACLR. Would this qualify for CPT 29888 with a 52 mod? The authors declare that they have no competing interests. Preoperative planning for revision ACL surgery is essential for a successful outcome. Typically, a staged procedure requires an average delay of 4 to 6months to allow for the bone defect to heal [11, 18], likely subjecting patients to a prolonged period of knee instability and thus adding to the risk of meniscal injury, additional deterioration of muscle strength, and osteochondrosis [32]. Franceschi et al. However, many authors prefer using an autograft for revision ACLR when possible. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. The https:// ensures that you are connecting to the Finally, 1 study compared ICBG to a synthetic bone substitute. In active young patients, failed primary ACLR may require a revision ACLR. -increased risk of critically short tunnels (<25 mm) and posterior tunnel wall blowout when a conventional offset guide is used
Bone Grafting Technique in Revision ACL Reconstruction: Coring Reamer <>
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. 3 0 obj
Unauthorized use of these marks is strictly prohibited. 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%). A 17-year-old female came to see us after two failed ACL surgeries. Cookies policy. Anterior cruciate ligament (ACL) reconstruction remains the gold-standard treatment for young active patients with functional instability after an ACL injury. At Mayo Clinic, we also are evaluating surgical techniques for ACL reconstruction, as well as optimal approaches to multiligament knee reconstruction.
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Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. Spine J 7:475490, Jenis LG, Banco RJ (2010) Efficacy of silicate-substituted calcium phosphate ceramic in posterolateral instrumented lumbar fusion. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Kim, DH., Bae, KC., Kim, DW. Autogenous grafts are considered the gold standard, due to their osteoinductive, osteoconductive, and osteogenic properties. <>>>
He did other procedures, but I have the codes for them. 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 .gov means its official. Two-stage revision anterior cruciate ligament reconstruction: a systematic review of bone graft options for tunnel augmentation.
Tibial Tunnel Bone Allograft Cpt - toyoulalar The mean time between the two stages was 8.8months and in the second stage, bone-biopsy specimens were taken from the tibia. Drilling a tibial tunnel at 40 degrees yields an average tunnel length of 45.442.18 mm.
ACL reconstruction - Mayo Clinic - Mayo Clinic - Mayo Clinic Levy, M.D., an orthopedic surgeon specializing in sports medicine at Mayo Clinic in Rochester, Minnesota, discusses Mayo's approach to revision ACL surgery. This adds a fair amount of complexity to the procedure. 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. Is it appropriate to assign codes for both the arthroscopic and open portions of the procedure? They are benign ganglion cysts that develop in or around the osseous tibial tunnel made during ACL reconstruction using the transtibial technique 1-2. J Knee Surg 17:127132, Mayr R, Rosenberger R, Agraharam D, Smekal V, El Attal R (2012) Revision anterior cruciate ligament reconstruction: an update. new ACL graft. Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. Patient age and activity level are also important factors when deciding on graft choice for revision procedures. 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 ]. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. Major reasons to proceed with a two-stage strategy include tunnel-widening or other loss of bone stock, tunnel malposition, arthrofibrosis, active infection, concomitant meniscal deficiency, malalignment, and focal chondral lesions and/or other ligamentous laxity that may require a staged approach [8, 9] (Table1). Your going to need to get very familiar with 2017 CMS NCCI Surgical Policy Manual. The anterior cruciate ligament (ACL) is a ligament that provides stability to the knee joint.
Bone-Patellar Tendon-Bone Autograft versus Hamstring Tendon Autograft 6 0 obj
[40] reported the results of 87 patients who underwent revision ACLR with a follow-up of more than 3 years. 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]. Clin Orthop Relat Res. 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. Wheeless' Textbook of Orthopaedics. - this technique allows for a more anatomic and precise placement of the femoral tunnel (more reliable posterior placement); 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. The results from this group were compared to the results of a matched group of patients with primary ACLR. An average Lysholm score at 2 years post operation was 96.6 points 2.1 (91100 points). 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. doi: 10.1016/j.eats.2020.08.024. 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. 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]. 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]. Root tears also put tremendous forces on the ACL graft and can lead to rotational instability and graft failure.
Graft healing in anterior cruciate ligament reconstruction I am still awaiting the OP note from the ASC, which takes weeks, so I can't post it.
What Is the Minimum Length of An Anterior Cruciate Ligament Autograft Femoral and Tibial Tunnel Bone Grafting for Stage 1 Revision ACL Reconstruction 10,878 views Apr 25, 2017 NewYorkOrtho 25K subscribers Notice.
Bone Graft of both bone tunnels (Knee) | Medical Billing and Coding Careers. - Discussion: registered for member area and forum access. 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. Would you like email updates of new search results? 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). Sometimes we can perform a biplanar osteotomy to correct both planes of deformity at once. 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. - Reflex extension loss afteranterior cruciate ligamentreconstruction due to femoral "high noon" graft placement. https://doi.org/10.1186/s43019-019-0010-6, DOI: https://doi.org/10.1186/s43019-019-0010-6. - anterior graft placement (relative to normal anatomical insertion of ACL) results in high strain on graft as knee is flexed;
- anteromedial portal technique: doi: 10.2106/JBJS.ST.20.00055. 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). Background: Ligament reconstruction is a common procedure in orthopedic surgery. eCollection 2021 Dec. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. proprioceptive reflex leading to a functional extension loss while the patient is awake. CT scans to confirm healing at 3-5months after bone grafting [4, 12, 33, 34]. ACL injuries most commonly occur during sports that involve sudden stops and changes in direction such as soccer, football, basketball and volleyball.
Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A 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. Purpose: To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. Clifford R. Wheeless, III, M.D. -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.. 2021 Oct 12;11(4):e20.00055.
Two-stage revision anterior cruciate ligament reconstruction No restrictions are placed on their range of motion and patients were allowed to weightbear on the affected leg using crutches [17]. eCollection 2022 Jun. We NEVER sell or give your information to anyone. official website and that any information you provide is encrypted Bone and Joint Clinic. TECHNIQUE STEPS. J Bone Joint Surg Am 100:9931000, Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. Hello, our physician bone grafted the previous ACL tunnels with allograft via arthroscopy. Philippe C, Marot V, Courtot L, Mesnier T, Reina N, Cavaignac E. Arthrosc Tech. A new and innovative procedure. All rights reserved. Clin Orthop Relat Res 325:130139, Andernord D, Desai N, Bjornsson H, Ylander M, Karlsson J, Samuelsson K (2015) Patient predictors of early revision surgery after anterior cruciate ligament reconstruction: a cohort study of 16,930 patients with 2-year follow-up. Recently, a technique for sterilizing musculoskeletal allografts using supercritical carbon dioxide (sCO2) has been developed [26]. 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. - A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction - The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Uchida et al. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. MeSH 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. [26] reported the use of a sCO2-sterilized bone allograft to fill tunnel defects as the first stage of a two-stage revision ACLR. My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. Epub 2005 Aug 10.
Tibial tunnel cyst | Radiology Reference Article | Radiopaedia.org Comparison of Femoral Tunnel Position and Clinical Results. 2020 Dec 21;9(12):e1917-e1925. 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. Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction? CT examinations were performed at 3, 12, and 24weeks after bone grafting. Abstract The . doi: 10.1016/j.eats.2022.01.004. CT analysis also included the determination of the filling rates of the tunnels. - Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study Predictors of clinical outcome following revision anterior cruciate ligament reconstruction. There is no code for bone grafting. Primary ACL reconstruction is recognized as a successful procedure, but failure has been shown to occur in approximately 10% of patients. For a better experience, please enable JavaScript in your browser before proceeding. The patients were divided into two groups based on the tunnel diameter (group A, <12mm; group B, <12mm). With each added degree of inclination, one gains 0.68 mm of tibial tunnel length.
PDF Acl Reconstruction With Allograft Cpt Code - annualreport.psg.fr Allografts may be well suited for recreational athletes older than 30years of age, but autografts may be a better choice for younger athletes who wish to return to higher-level athletics [4]. You must log in or register to reply here. - graft was placed on the femoral site in the high noon position combined with a slight medial tibial tunnel placement;
Bone graft substitute for tunnel filling improved ACL - Healio 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. and transmitted securely. Anterior cruciate ligament (ACL) reconstruction rates have increased over the past 20years to roughly 200,000 per year [1]. No, I'm sorry that was my bad, you did say allograft, I just overlooked it. - open technique(which might be required with arthroscopy malfunction). 2022 Feb 28;11(3):e463-e469. You are using an out of date browser. Measurements are made perpendicular to the axial plane of the tunnel at the widest point [15]. Arthrosc Tech. femoral tunnel too far anterior in the notch; Bone graft, any donor area; minor or small eg, dowel or button) (20900) Bone graft, any donor area; major or large (20902) Insertion vascular pedicle into carpal bone (25430) Bone marrow; aspiration only (38220) Bone marrow transplantation; autologous (38241) Microvascular. Disclaimer. Revision anterior cruciate ligament (ACL) reconstruction is becoming more frequent, especially in specialized centers, because of the large numbers of primary ACL procedures performed. Arch Orthop Trauma Surg. Two-stage revision anterior cruciate ligament reconstruction. The femoral tunnel was a little high. Thomas et al. This content does not have an English version. For example, patients may require bone grafting of prior graft tunnels, and then have the ACL revision in a second stage. JavaScript is disabled. Knee Surg Sports Traumatol Arthrosc 20:12981306, Brown CH Jr, Carson EW (1999) Revision anterior cruciate ligament surgery. JavaScript is disabled. Towson, MD 21204
Terms and Conditions,
Bone Tunnel Management in Modern Revision Anterior Cruciate Ligament Correspondence to 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. Example: 29888 - ACL Repair G0289 - Arthroscopy, knee, surgical, for removal of loose body, Harvesting and inserting the graft is included in code . Study design: government site.