Predictors of clinical outcome following revision anterior cruciate ligament reconstruction. - resulting anterior-posterior cruciate ligament impingement near extension caused a persistentfunctional extension deficit of 20; anterior cruciate ligament; bone graft; knee; revision. There are several techniques for bone grafting tunnels in one- or two-staged ACL revision procedures with either autograft or allograft. "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. Van de pol et al. eCollection 2022 Jun. registered for member area and forum access. You must log in or register to reply here. J Orthop Sci (2010) . Disclaimer. No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. 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. Privacy Louis et al. The use of allograft material negates the issue of donor-site morbidity but carries the potential risk of disease or infection transmission [23, 24]. 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. - references: The bone grafting is an opportune time to do an osteotomy to correct the malalignment. 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. Please enable it to take advantage of the complete set of features! 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? 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. PDF ACL reconstruction revision with staged bone grafting Thomas et al. - over the top repair tensioned in extension will provide support in terminal extension but may slacken at greater flexion angles; Mosaicplasty. Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. 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]. Clin Radiol 68:e552e559, Marchant MH Jr, Willimon SC, Vinson E, Pietrobon R, Garrett WE, Higgins LD (2010) Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction. - this technique allows for a more anatomic and precise placement of the femoral tunnel (more reliable posterior placement); If no autograft is available for revision surgery, they advise augmentation of the allograft with the lateral extra-articular iliotibial band procedure to reduce the high failure rate associated with the use of the allograft. Femoral and Tibial Tunnel Bone Grafting for Stage 1 Revision ACL He is only grafting the bone. 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 . 6 0 obj 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. Kim, DH., Bae, KC., Kim, DW. They recommended that two-stage reconstruction could be safely performed at 24weeks after bone grafting by the iliac-bone block-grafting technique. 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. The surgeon should be sure to "bottom out" the cannula stylet into the femoral tunnel and allow the bone graft to gently push the stylet out of the tunnel as it is being filled . 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. Patients who underwent ACL reconstruction (Current Procedural Terminology (CPT) code 29888) between 20 were identified using the PearlDiver database. Tibial tunnel was found to be anterior, perhaps more inferior than would be in an anatomic ACL insertion. doi: 10.1016/j.eats.2022.01.004. 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. At a mean follow-up of 6years, the laxity measurements achieved with a two-stage revision ACLR can be similar to those achieved after primary ACLR, although the IKDC rating is lower. Hi you mentioned this was a staged procedure - any chance you can post the entire operative report without patient info? https://doi.org/10.1186/s43019-019-0010-6, DOI: https://doi.org/10.1186/s43019-019-0010-6. - consider whether there is an interplay between posterior graft placement and appropriate graft tension; [40] reported the results of 87 patients who underwent revision ACLR with a follow-up of more than 3 years. official website and that any information you provide is encrypted Clinically, many authors have reported good results for two-staged revision ACLR using autograft bone [4, 11]. [31] used Si-CaP for a bone-graft substitute for tunnel augmentation in two-stage revision ACLR. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 2022 May 11;11(6):e971-e976. Epub 2020 Apr 1. ]+yC`6Hd Ql]M 3w7ah;HNdyS*7x-zq^/4%^6eA$m@(,ly}U[N9E(/=iHCL")d6yx]K7!84,q!r~#6mE8dIS69eYn 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. Unauthorized use of these marks is strictly prohibited. Secure graft fixation is critical in ensuring a successful two-staged ACLR. <> Comparison of Femoral Tunnel Position and Clinical Results. Bone tunnel-related issues are frequently encountered during revision anterior cruciate ligament reconstruction. - over the top position: The slope causes the tibia to move forward and the femur to fall backward, putting tremendous strain on the ACL. An official website of the United States government. Currently, the gold standard for measuring tunnel size is the computed tomography (CT) method. The two-stage group contained significantly more patients with meniscal and chondral pathology compared with the primary ACLR group. A total 75 patients (75 knees) who underwent ACL reconstruction with tibialis anterior allografts were investigated between February 2015 and October . Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. eCollection 2021 Oct-Dec. von Recum J, Schwaab J, Guehring T, Grtzner PA, Schnetzke M. Arthroscopy. The mean time between the two stages was 8.8months and in the second stage, bone-biopsy specimens were taken from the tibia. A tamp is used to further compress the graft. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 960 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Two-stage revision anterior cruciate ligament reconstruction. Measurements are made perpendicular to the axial plane of the tunnel at the widest point. See our privacy policy. eCollection 2021 Dec. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. CAS For a better experience, please enable JavaScript in your browser before proceeding. endobj Femoral and Tibial Tunnel Bone Grafting for Stage 1 Revision ACL Reconstruction 10,878 views Apr 25, 2017 NewYorkOrtho 25K subscribers Notice. 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]. The authors declare that they have no competing interests. Graft healing in anterior cruciate ligament reconstruction Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. 2018 Apr-Jun;9(2):116-120. doi: 10.1016/j.jcot.2018.02.010. PDF Acl Reconstruction With Allograft Cpt Code - annualreport.psg.fr 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. J Bone Joint Surg Am 100:9931000, Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. This provides a cylindrical graft, which is delivered to the femoral tunnel through the arthroscopic portal. Philippe C, Marot V, Courtot L, Mesnier T, Reina N, Cavaignac E. Arthrosc Tech. CT scans to confirm healing at 3-5months after bone grafting [4, 12, 33, 34]. 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.
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