- Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. Tunnel widening is generally cavitary, frequently maximal in the mid-zone of the tibial tunnel. Spine (Phila Pa 1976) 20:10551060, Campbell DG, Li P (1999) Sterilization of HIV with irradiation: relevance to infected bone allografts. He did other procedures, but I have the codes for them. 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. Preoperative planning is critical to identify and characterize bone tunnel pathology. While one-stage revision ACLR is well described and reported, few studies have reported the outcomes of two-stage revision ACLR. Her alignment, tibial slope and cartilage were all normal. 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. Cookies policy. They observed that an average of 5.8months was needed for healing of the autograft dowel to become visible on CT scans [11]. 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]. However, Thomas et al. 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. Hi you mentioned this was a staged procedure - any chance you can post the entire operative report without patient info? Biomaterials 27:50145026, Hing KA, Wilson LF, Buckland T (2007) Comparative performance of three ceramic bone graft substitutes. 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. endobj 2021 Oct 12;11(4):e20.00055. You are using an out of date browser. Bruce A. - lateral tunnel placement: Only 44 patients underwent a staged revision ACLR after bone grafting and 10 patients refused to undergo a revision ACLR. For example, patients may require bone grafting of prior graft tunnels, and then have the ACL revision in a second stage. - Surgical Technique: Reflex extension loss afteranterior cruciate ligamentreconstruction due to femoral "high noon" graft placement. - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. [38] have reported the outcomes of revision ACLR with and without lateral extra-articular tenodesis. - over the top repair tensioned in extension will provide support in terminal extension but may slacken at greater flexion angles; 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. You must log in or register to reply here. 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/. [26] reported the use of a sCO2-sterilized bone allograft to fill tunnel defects as the first stage of a two-stage revision ACLR. They are benign ganglion cysts that develop in or around the osseous tibial tunnel made during ACL reconstruction using the transtibial technique 1-2. - Editorial: The Lateral Intercondylar RidgeA Key to Anatomic Anterior Cruciate Ligament Reconstruction 2005 Nov;33(11):1701-9. doi: 10.1177/0363546505276759. eCollection 2020 Dec. Prall WC, Kusmenkov T, Schmidt B, Frmetz J, Haasters F, Naendrup JH, Bcker W, Shafizadeh S, Mayr HO, Pfeiffer TR. 8 Therefore, one should avoid angles <40 to 45 . - surgeon will also note more perpendicular drill angle to bone surface with AM vs TransTibial drilling; Federal government websites often end in .gov or .mil. Enjoy a guided tour of FindACode's many features and tools. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2013;41:1296. Predictors of clinical outcome following revision anterior cruciate ligament reconstruction. ACL injuries most commonly occur during sports that involve sudden stops and changes in direction such as soccer, football, basketball and volleyball. FOIA 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. An official website of the United States government. 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 arthroscopic anterior cruciate ligament repair, a tibial incision was made through subcutaneous tissue to access the tibial tunnel in order to remove the deep hardware. 1). Meniscal tears are another contributing cause. 2020 Dec 21;9(12):e1917-e1925. 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. The purpose of this article is to review the preoperative planning, surgical considerations, rehabilitation, and outcomes of two-stage revision ACL reconstructions and summarize the recent literature outlining treatment results. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. 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. After 6 to 12weeks, failures tend to occur in mid-substance [11]. Houston Methodist Orthopedics & Sports Medicine. Noyes et al. Before Two-stage revision ACLR should be considered in cases of tunnel lysis, infection, malalignment, meniscal deficiency, or chondral lesions. 1 0 obj 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]. - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. ]+yC`6Hd Ql]M 3w7ah;HNdyS*7x-zq^/4%^6eA$m@(,ly}U[N9E(/=iHCL")d6yx]K7!84,q!r~#6mE8dIS69eYn #1. TECHNIQUE VIDEO. Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? Unless you probe for a root tear during surgery, you may miss it. Thomas et al. It may not display this or other websites correctly. Two-stage revision anterior cruciate ligament reconstruction. 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 . Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery. Abstract The . 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 ]. 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. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. All the patients in the study underwent screw removal and filling of the tunnels with an autograft harvested from the anterior tibial metaphysis. Tibial tunnel was found to be anterior, perhaps more inferior than would be in an anatomic ACL insertion. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. Radiographic evaluation of bone graft integration after the first stage was reported in 4 studies, with an average duration of 4.9 months. Yoon et al. There has been a long-standing debate as to whether an autograft or an allograft should be used for revision ACLR. To read the full article, sign in and subscribe to the AHA Coding Clinic for HCPCS. The femoral tunnel was a little high. <> Before performed a CT scan at 4months to assess healing of the bone graft in the tibial tunnel. Measurements are made perpendicular to the axial plane of the tunnel at the widest point. eCollection 2021 Oct-Dec. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. ACL graft can replicate the normal ligament's tension curve. Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction? Bone Grafting Technique in Revision ACL Reconstruction: Coring Reamer and Dowel Trick. Outcomes of repeat revision 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 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. Federal government websites often end in .gov or .mil. Guide pins were placed in the tibial tunnel and next putty and dowels (grafts) were placed in the tibial and femoral tunnels. (D-F) Coronal and axial computed tomography images showing bone tunnel dilatation (femoral, 15.7 mm; tibial, 9.8 mm). official website and that any information you provide is encrypted - Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position . Epub 2018 Dec 17. 2. 2017 Apr;33(4):819-827. doi: 10.1016/j.arthro.2016.10.007. 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. A clinical, prospective, randomized, double-blind study, Femoral Shaft Frx: Leg Lengths / Nail Lengths, Orthopaedic Specialists of North Carolina. Orthopaedic Specialists of North Carolina. An official website of the United States government. Stage I femoral and tibial bone grafting. MeSH 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 theory, the sCO2-sterilized graft only provides osteoconductive properties to the grafted bone tunnels. 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. PMC Franceschi F, Papalia R, Di Martino A, Rizzello G, Allaire R, Denaro V. Arthroscopy. A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction. Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. - this technique allows for a more anatomic and precise placement of the femoral tunnel (more reliable posterior placement); eCollection 2022 Jun. Arthroscopic knee procedure CPT codes range from 29866 to 29889. 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. TJ!!X`Sz9Q*BeV={=F ' 0y^*2| '! Please enable it to take advantage of the complete set of features! doi: 10.1016/j.arthro.2006.07.054. Resurfacing technique consisting of transplantation of multiple osteochondral grafts to smooth the area. One-Stage ACL Revision Using a Bone Allograft Plug for a Semianatomic Tibial Tunnel That Is Too Anterior. Previous literature has reported that if the tunnel size exceeds 1015mm, two-stage surgery should be performed. When performing a revision reconstruction, the surgeon decides between a single-stage or a two-stage revision. National Library of Medicine Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. CT scans to confirm healing at 3-5months after bone grafting [4, 12, 33, 34]. proprioceptive reflex leading to a functional extension loss while the patient is awake. - references: It does not hit an edit, but be prepared for insurance to deny it. - Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. American Journal of Sports Medicine. The important stages in assessing a patient with failed ACL surgery include history, patient selection, physical examination and investigations, choice of graft, surgical technique, and rehabilitation [7]. Spine J 7:475490, Jenis LG, Banco RJ (2010) Efficacy of silicate-substituted calcium phosphate ceramic in posterolateral instrumented lumbar fusion. 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]. It may not display this or other websites correctly. doi: 10.1016/j.eats.2020.08.024. The .gov means its official. femoral tunnel too far anterior in the notch; The analysis included 7 studies with a total of 234 patients. Correspondence to - Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. Discover how to save hours each week. 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. [40] reported the results of 87 patients who underwent revision ACLR with a follow-up of more than 3 years. - graft that tightens (pulls up into the tibial tunnel) with flexion will have a much higher likelyhood offailure and usually indicates a ACL Reconstruction - BTB Graft. Phys Ther 85:740749, PubMed <> Purposes: We sought to introduce our new technique of Bashti bone plug for fixation of soft tissue graft in anterior cruciate ligament (ACL) reconstruction and to compare . [11] reported the results of 49 consecutive two-stage revision ACLRs in which the tibial tunnel was grafted (the bone graft was taken from the ipsilateral iliac crest) during the first stage, followed by an ACLR using various grafts and fixation methods for the second stage. Currently, the gold standard for measuring tunnel size is the computed tomography (CT) method. 8600 Rockville Pike The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. PubMedGoogle Scholar. For assessment of bone-graft incorporation, radiographs are routinely used. [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. Epub 2020 Apr 1. new ACL graft. Autogenous grafts are considered the gold standard, due to their osteoinductive, osteoconductive, and osteogenic properties. A Meta-analysis of 47,613 Patients. In cases like these your going to need to bill out "what you can" which in this case would be 20680. Conclusion: Ramp tears can lead to rotational instability and put excessive strain on the ACL graft, causing it to fail. Springer Nature. The site is secure. <> - 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; This adds a fair amount of complexity to the procedure. 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. JavaScript is disabled. doi: 10.1016/j.eats.2021.08.013. The mean time between the two stages was 8.8months and in the second stage, bone-biopsy specimens were taken from the tibia. 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. Increasing expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions require precise knowledge of technical details such as minimum intra-femoral tunnel graft lengths. Arthrosc Tech 5:e189e195, Hofbauer M, Muller B, Murawski CD, Baraga M, van Eck CF, Fu FH (2013) Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction. <> Would this qualify for CPT 29888 with a 52 mod? Thomas NP, Kankate R, Wandless F, Pandit H. Am J Sports Med. 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]. Purpose: Two years after the surgery, she resumed all activities and plays collegiate volleyball. Finally, 1 study compared ICBG to a synthetic bone substitute. Keep your critical coding and billing tools with you no matter where you work. Therefore, the coronal and sagittal images (four-tunnel view; femur-coronal, tibia-coronal, femur-sagittal, tibia-sagittal) are primarily used (Fig. 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. Conclusions. 2015;43:2510. doi: 10.1016/j.eats.2022.01.004. In active young patients, failed primary ACLR may require a revision ACLR. - Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring 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]. Primary ACL reconstruction is recognized as a successful procedure, but failure has been shown to occur in approximately 10% of patients. 1998-2023 Mayo Foundation for Medical Education and Research. eCollection 2022 Jul. (C) Sagittal magnetic resonance imaging showing insufficiency of the anterior cruciate ligament graft. registered for member area and forum access. Trojani et al. He did other procedures, but I have the codes for them. The results from this group were compared to the results of a matched group of patients with primary ACLR. -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.. government site. Patrick C. McCulloch MD. 2002 Richard O'Connor Award paper. Revision anterior cruciate ligament (ACL) reconstruction is becoming more frequent, especially in specialized centers, because of the large numbers of primary ACL procedures performed. - Discussion: Two-Stage Revision Anterior Cruciate Ligament Reconstruction with Cannulated Allograft Bone Dowels Soaked in Bone Marrow Aspirate Concentrate. Drilling a tibial tunnel at 40 degrees yields an average tunnel length of 45.442.18 mm. JavaScript is disabled. 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). Mosaicplasty. 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? At Mayo Clinic, we also are evaluating surgical techniques for ACL reconstruction, as well as optimal approaches to multiligament knee reconstruction. 4 0 obj The goal is to ensure patients of all activity levels, from professional to recreational, have the surgeries that meet their individual needs. Aust N Z J Surg 69:517521, Eagan MJ, McAllister DR (2009) Biology of allograft incorporation. Manage cookies/Do not sell my data we use in the preference centre. - ACL graft should pull up intotibial tunnel by about 2mm with extension when fixed on femoral side; 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]. Arthroscopy 33:819827, Diamantopoulos AP, Lorbach O, Paessler HH (2008) Anterior cruciate ligament revision reconstruction: results in 107 patients. - this restricts flexion of knee if graft remains intact, or it may elongate graft if the range of motion is restored; - posterior placement or distal to normal site of attachment results in excessive tightening of the graft when knee is extended; Given our prior assumption of the STC being 45 mm, the graft-50 rule suggests a 45-mm tibial tunnel if using 25-mm bone plugs. - A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction - ref: Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. We routinely obtain hip-to-ankle AP X-rays to assess for any coronal plane malalignment. According to the result of the multicenter ACL Revision Study (MARS) Group, the risk of graft re-rupture following revision ACLR in patients receiving an autograft is 2.78 times less likely than in those receiving an allograft [35]. Methods: Physical therapy with muscle-strengthening and proprioceptive training can be performed. 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. Some authors have described the additional use of CT scans to confirm healing at 35months after bone grafting [4, 12, 33, 34]. Our Experience: 2014 - 2018 . 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 . Jul 22, 2009. Enhancement of tendon-to-bone healing after anterior cruciate ligament reconstruction using bone marrow-derived mesenchymal stem cells genetically modified with bFGF/BMP2. I am still awaiting the OP note from the ASC, which takes weeks, so I can't post it. Femoral and Tibial Tunnel Bone Grafting for Stage 1 Revision ACL Reconstruction 10,878 views Apr 25, 2017 NewYorkOrtho 25K subscribers Notice. National Library of Medicine Background: Ligament reconstruction is a common procedure in orthopedic surgery. Franceschi et al. Preoperative planning for revision ACL surgery is essential for a successful outcome. - two incision technique (outside in) There are several techniques for bone grafting tunnels in one- or two-staged ACL revision procedures with either autograft or allograft. CT analysis also included the determination of the filling rates of the tunnels. endobj 5 0 obj -allows the femoral attachment point to overlap the anterolateral and posteromedial bundles insertion site 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. Eur Spine J 22(Suppl 2):S185S194, von Recum J, Schwaab J, Guehring T, Grutzner PA, Schnetzke M (2017) Bone incorporation of silicate-substituted calcium phosphate in 2-stage revision anterior cruciate ligament reconstruction: a histologic and radiographic study. [11] noted that this suggestion is unnecessary, as using a two-stage technique ensures that there is good-quality bone around the tunnels, and the initial graft fixation is as secure as in the primary reconstruction. The femoral tunnel was easily visualized with flexing the knee beyond 90 degrees. A new and innovative procedure. However, many authors prefer using an autograft for revision ACLR when possible. But an iliac-crest autograft is comparatively invasive with relatively high donor-site morbidity and the potential for insufficient yield quantities [11, 22]. % - figure four flexedpositionassist with providing the best femoral target; Levy, M.D., an orthopedic surgeon specializing in sports medicine at Mayo Clinic in Rochester, Minnesota, discusses Mayo's approach to revision ACL surgery. Cite this article. View all the articles associated with any code, right from the code page. 2017 Jun;99-B(6):714-723. doi: 10.1302/0301-620X.99B6.BJJ-2016-0929.R2. 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. 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. Excessive tibial slope also puts patients at much higher risk of early ACL reconstruction failure. 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]. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. 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? Data Trace is the publisher of Comparison of Femoral Tunnel Position and Clinical Results. Lee et al. If this is your first visit, be sure to check out the. - 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. 2 0 obj Inferior tendon graft to bone tunnel healing at the tibia compared to that at the femur after anterior cruciate ligament reconstruction. Would you like email updates of new search results? Si-CaP appears to provide a more stable osteoconductive scaffold to support faster angiogenesis. A tamp is used to further compress the graft. (A, B) Anteroposterior and lateral knee radiographs showing bone tunnel positioning, widening, and retained biocomposite screw. 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. Arthrosc Tech. 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. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. Biazzo A, Manzotti A, Motavalli K, Confalonieri N. J Clin Orthop Trauma. Diermeier et al. He is only grafting the bone. 4. Background: 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. <> Surgery is often recommended to restore knee strength and function by reconstructing a damaged ACL with a graft. Knee Surg & Relat Res 31, 10 (2019). et al. 2023 BioMed Central Ltd unless otherwise stated. doi: 10.1016/j.eats.2022.03.024. Pre-op imaging shows excessive tunnel and socket widening and no malalignment with normal slope. Does the type of graft affect the outcome of revision anterior cruciate ligament reconstruction? One of the main factors associated with tunnel enlargement is malposition of the tibial tunnel, which likely leads to graft micromotion. Ki-Cheor Bae. 2021 Oct 12;11(4):e20.00055. -notchplasty Two-stage revision anterior cruciate ligament reconstruction: a systematic review of bone graft options for tunnel augmentation.