bone graft acl tunnel cpt

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Recently, a technique for sterilizing musculoskeletal allografts using supercritical carbon dioxide (sCO2) has been developed [26]. No, I'm sorry that was my bad, you did say allograft, I just overlooked it. (C) Sagittal magnetic resonance imaging showing insufficiency of the anterior cruciate ligament graft. Data Trace is the publisher of It is technically difficult to deliver and impact bone graft into the femoral tunnel with the standard surgical and arthroscopic instruments. 2017 Oct;475(10):2459-2468. doi: 10.1007/s11999-017-5278-9. Anterior cruciate ligament reconstruction, Ohly NE, Murray IR, Keating JF (2007) Revision anterior cruciate ligament reconstruction: timing of surgery and the incidence of meniscal tears and degenerative change. Arthrosc Tech. "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. Bone Graft related CPT Codes - eatonhand.com 2002 Richard O'Connor Award paper. I am still awaiting the OP note from the ASC, which takes weeks, so I can't post it. Philippe C, Marot V, Courtot L, Mesnier T, Reina N, Cavaignac E. Arthrosc Tech. [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. -Morphology of the Femoral Intercondylar Notch - graft was placed on the femoral site in the high noon position combined with a slight medial tibial tunnel placement; Bone Tunnel Management in Modern Revision Anterior Cruciate Ligament 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 . - under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. Make a donation. 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. Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? We routinely obtain hip-to-ankle AP X-rays to assess for any coronal plane malalignment. Unauthorized use of these marks is strictly prohibited. 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. Increasing expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions require precise knowledge of technical details such as minimum intra-femoral tunnel graft lengths. Autograft was used in 4 studies: iliac crest bone autograft (ICBG, n = 3) and tibial bone autograft (TBA, n = 1). - references: The appropriately sized OATS harvester is chosen 1 mm larger than the tunnel size and is used to harvest bone graft from the iliac crest through a percutaneous approach. Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. They found that a sCO2-sterilized bone allograft showed graft incorporation and remodeling through creeping substitution. The indications for staged ACL reconstruction and the rehabilitation protocol between stages need to be clearly established. Finally, 1 study compared ICBG to a synthetic bone substitute. 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. . Jul 22, 2009. Ligaments are strong bands of tissue that attach one bone to . Primary ACL reconstruction is recognized as a successful procedure, but failure has been shown to occur in approximately 10% of patients. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. Preoperative planning for revision ACL surgery is essential for a successful outcome. Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. Therefore, the coronal and sagittal images (four-tunnel view; femur-coronal, tibia-coronal, femur-sagittal, tibia-sagittal) are primarily used (Fig. National Library of Medicine It may not display this or other websites correctly. Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. An active infection should be treated with irrigation and debridement with confirmation of eradication (e.g., normalized laboratory test results, negative cultures) before a patient has a new graft and implant put in place. a statistical evaluation. The bone grafting is an opportune time to do an osteotomy to correct the malalignment. Neil Duplantier MD. Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. Enhancement of tendon-to-bone healing after anterior cruciate ligament reconstruction using bone marrow-derived mesenchymal stem cells genetically modified with bFGF/BMP2. Clifford R. Wheeless, III, M.D. - The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint bone graft acl tunnel cpt - juliocarmona.com Knee Surg & Relat Res 31, 10 (2019). 5 0 obj 2021 Nov 16;10(12):e2699-e2708. - Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. and transmitted securely. 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. -Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. Previous literature has reported that if the tunnel size exceeds 1015mm, two-stage surgery should be performed. sharing sensitive information, make sure youre on a federal An Observational Study Using Navigated Measurements. Two-stage revision anterior cruciate ligament reconstruction: a systematic review of bone graft options for tunnel augmentation. 3 0 obj Background: No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. 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. At Mayo Clinic, we also are evaluating surgical techniques for ACL reconstruction, as well as optimal approaches to multiligament knee reconstruction. It is commonly injured during high-intensity sports. 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. Arthroscopic Delivery of Injectable Bone Graft for Staged Revision government site. Then in that case, yes, I would code this as 29888-52. In theory, the sCO2-sterilized graft only provides osteoconductive properties to the grafted bone tunnels. PubMedGoogle Scholar. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. -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.. Bone Grafting Technique in Revision ACL Reconstruction: Coring Reamer and Dowel Trick. 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. Salem HS, Axibal DP, Wolcott ML, et al. Bethesda, MD 20894, Web Policies J Knee Surg 17:127132, Mayr R, Rosenberger R, Agraharam D, Smekal V, El Attal R (2012) Revision anterior cruciate ligament reconstruction: an update. All the patients in the study underwent screw removal and filling of the tunnels with an autograft harvested from the anterior tibial metaphysis. CT scans to confirm healing at 3-5months after bone grafting [4, 12, 33, 34]. Sometimes we can perform a biplanar osteotomy to correct both planes of deformity at once. This content does not have an English version. 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 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. Lee et al. Please enable it to take advantage of the complete set of features! 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 J Bone Joint Surg Am 76:10191031, Richter DL, Werner BC, Miller MD (2017) Surgical pearls in revision anterior cruciate ligament surgery: when must I stage? TECHNIQUE STEPS. Uchida et al. statement and Tibial Tunnel Bone Allograft Cpt Code For The. 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. Federal government websites often end in .gov or .mil. - Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. 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]. 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. - this restricts flexion of knee if graft remains intact, or it may elongate graft if the range of motion is restored; [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 . An Observational Study Using Navigated Measurements 2018 Apr-Jun;9(2):116-120. doi: 10.1016/j.jcot.2018.02.010. Arthrosc Tech. Phys Ther 85:740749, PubMed Mosaicplasty. Epub 2018 Feb 23. 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. With each added degree of inclination, one gains 0.68 mm of tibial tunnel length. Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. - Editorial: The Lateral Intercondylar RidgeA Key to Anatomic Anterior Cruciate Ligament Reconstruction Bone Graft related CPT Codes. 6 0 obj The site is secure. Bone graft substitute for tunnel filling improved ACL reconstruction Arch Orthop Trauma Surg 132:12991313, Thomas NP, Kankate R, Wandless F, Pandit H (2005) Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel. My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. Levy, M.D., an orthopedic surgeon specializing in sports medicine at Mayo Clinic in Rochester, Minnesota, discusses Mayo's approach to revision ACL surgery. eCollection 2020 Dec. Prall WC, Kusmenkov T, Schmidt B, Frmetz J, Haasters F, Naendrup JH, Bcker W, Shafizadeh S, Mayr HO, Pfeiffer TR. 2005 Nov;33(11):1701-9. doi: 10.1177/0363546505276759. - references: 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]. Unable to load your collection due to an error, Unable to load your delegates due to an error. - 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; 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. Study design: - Drilling the Femoral Tunnel During ACL Reconstruction: Transtibial Versus Anteromedial Portal Techniques. Knee-laxity measurements were elevated in the without-revision group, but the difference was not significant. 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. Preoperative planning is critical to identify and characterize bone tunnel pathology. Femoral and Tibial Tunnel Bone Grafting for Stage 1 Revision ACL Reconstruction 10,878 views Apr 25, 2017 NewYorkOrtho 25K subscribers Notice. Currently, the gold standard for measuring tunnel size is the computed tomography (CT) method. A new technique for femoral and tibial tunnel bone grafting using the J Bone Joint Surg Br 89:10511054, Article - this technique allows for a more anatomic and precise placement of the femoral tunnel (more reliable posterior placement); - ref: Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. By using this website, you agree to our Arthroscopic Revision of Attenuated Anterior Cruciate Ligament Graft With Enlarged Bone Tunnels Using Injectable Bone Graft Substitute. Ramp tears can lead to rotational instability and put excessive strain on the ACL graft, causing it to fail. - Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position . i came across this in cpt a revision acl reconstruction and i came anterior, price 8 900 cpt code 29888 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 However, with precise indications, proper preoperative planning and operative-technique selection, two-stage revision ACLR can achieve favorable outcomes. Root tears also put tremendous forces on the ACL graft and can lead to rotational instability and graft failure. Purpose: To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. Similarly, a patient with a loss of more than 5 of extension or 20 of flexion of knee motion should be considered for lysis of adhesions and manipulation under anesthesia followed by rehabilitation [4, 10]. Arch Orthop Trauma Surg. - A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction 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. - over the top repair tensioned in extension will provide support in terminal extension but may slacken at greater flexion angles; - Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. Hello, our physician bone grafted the previous ACL tunnels with allograft via arthroscopy. JCM | Free Full-Text | Femoral Tunnel Position Affects Postoperative 2020;38:1191. This site needs JavaScript to work properly. Cancel anytime. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. 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. anterior cruciate ligament; bone graft; knee; revision. 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. 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. doi: 10.1016/j.eats.2021.08.013. If this is your first visit, be sure to check out the. 8600 Rockville Pike Use of silicate-substituted calcium phosphate bone substitute had equivalent knee laxity and clinical function outcomes compared with autologous bone graft 3 years after two-stage ACL . -increased risk of critically short tunnels (<25 mm) and posterior tunnel wall blowout when a conventional offset guide is used One comparative cohort study reported that objective outcomes and subjective patient scores and satisfaction were not significantly different between one-stage and two-stage revision ACLRs and both groups had significantly improved objective outcomes and patient subjective outcomes without notable differences in failure rates [42]. Reports suggest that a two-stage procedure is performed in only 8 to 9% of revision ACLRs [6]. 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. 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). Some authors have described the additional use of CT scans to confirm healing at 35months after bone grafting [4, 12, 33, 34]. endobj - Discussion: 2020;48(3):767-777. 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. They recommended that two-stage reconstruction could be safely performed at 24weeks after bone grafting by the iliac-bone block-grafting technique. Successful revision surgery requires an understanding of the cause of failure, careful preoperative planning, meticulous surgical execution, proper postoperative rehabilitation, and appropriate patient counseling [4]. Numerous studies have reported that additional procedures (e.g., extra-articular tenodesis, anatomical anterolateral ligament (ALL) reconstruction) could be a meaningful option in cases of revision ACLR to improved rotatory stability which is associated with re-injury. A clinical, prospective, randomized, double-blind study, Femoral Shaft Frx: Leg Lengths / Nail Lengths, Orthopaedic Specialists of North Carolina. 2022 May 11;11(6):e971-e976. Biomaterials 27:50145026, Hing KA, Wilson LF, Buckland T (2007) Comparative performance of three ceramic bone graft substitutes. Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. 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. Orthopaedic Specialists of North Carolina. A Retrospective Comparative Study. Is it appropriate to assign codes for both the arthroscopic and open portions of the procedure? - Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation Manage cookies/Do not sell my data we use in the preference centre. One-Stage ACL Revision Using a Bone Allograft Plug for a Semianatomic Tibial Tunnel That Is Too Anterior. Varus or valgus malalignment can put strain on an ACL graft, whatever the malalignment's cause the patient's physiology, failed meniscal surgery or cartilage problems. JavaScript is disabled. Revision anterior cruciate ligament (ACL) reconstruction is becoming more frequent, especially in specialized centers, because of the large numbers of primary ACL procedures performed. 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. 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. Hello, our physician bone grafted the previous ACL tunnels with allograft via arthroscopy. -main criticism is that in some cases a transtibial tunnel will not allow for the exact desiredtunnel placement (you get what you get) 2023 BioMed Central Ltd unless otherwise stated. - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. At a mean follow-up 6.7years postoperatively, 66.7% of patients had returned to their preoperative sports activity level, 23.3% had changed to lower, non-impact sports, and 10% had given up any sports activity. doi: 10.1016/j.eats.2020.08.024. Comparing Bone-Tendon Autograft With Bone-Tendon-Bone Autograft for ACL 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. 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]. Her alignment, tibial slope and cartilage were all normal. 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]. Get timely coding industry updates, webinar notices, product discounts and special offers. Epub 2018 Dec 17. - over the top position: Biazzo A, Manzotti A, Motavalli K, Confalonieri N. J Clin Orthop Trauma. For a better experience, please enable JavaScript in your browser before proceeding. - graft that tightens (pulls up into the tibial tunnel) with flexion will have a much higher likelyhood offailure and usually indicates a View all the articles associated with any code, right from the code page. Thomas et al. - most common error is non isometric anterior tunnel placement within intercondylar notch rather than at its normal posterior insertion; J Bone Joint Surg Am 100:9931000, Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. Study design: Systematic review. 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. Before Graft healing in anterior cruciate ligament reconstruction 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 . Methods: 2022 Feb 28;11(3):e463-e469. endobj 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. Measurements are made perpendicular to the axial plane of the tunnel at the widest point. Radiographic evaluation of bone graft integration after the first stage was reported in 4 studies, with an average duration of 4.9 months. Resurfacing technique consisting of transplantation of multiple osteochondral grafts to smooth the area. This adds a fair amount of complexity to the procedure. Revision ACL surgery: A comprehensive approach - Mayo Clinic JavaScript is disabled. 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. Femoral and Tibial Tunnel Bone Grafting for Stage 1 Revision ACL Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Spine (Phila Pa 1976) 20:10551060, Campbell DG, Li P (1999) Sterilization of HIV with irradiation: relevance to infected bone allografts. https://doi.org/10.1186/s43019-019-0010-6, DOI: https://doi.org/10.1186/s43019-019-0010-6. ",#(7),01444'9=82. Clipboard, Search History, and several other advanced features are temporarily unavailable. Samuelsen BT, Webster KE, Johnson NR, Hewett TE, Krych AJ. Terms and Conditions, doi: 10.2106/JBJS.ST.20.00055. Unauthorized use of these marks is strictly prohibited. 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/. An official website of the United States government. 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. Some authors suggest that an accelerated rehabilitation program for revision ACLR is not appropriate because of weaker initial graft fixation [20]. There is no code for bone grafting. Consistent Indications and Good Outcomes Despite High Variability in