The insertion of an interference screw not only compresses the graft in the tunnel but also leads to an enlargement of the bone tunnel itself [13]. Stage I femoral and tibial bone grafting. 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]. doi: 10.1016/j.eats.2020.08.024. Evaluations were performed in the axial plane of the tibia using three parameters (occupying ratio, union ratio, and bone mineral density). Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. In 2-stage revisions, bone grafting of the tunnels may be undertaken if the primary position was inaccurate or if osteolysis has caused widening of the tunnels. You are using an out of date browser. endobj
1). No, I'm sorry that was my bad, you did say allograft, I just overlooked it. Epub 2018 Dec 17. 2. Additionally, graft-tunnel mismatch is problematic, often leading to inadequate osseous . Clinically, many authors have reported good results for two-staged revision ACLR using autograft bone [4, 11]. and transmitted securely. Increasing expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions require precise knowledge of technical details such as minimum intra-femoral tunnel graft lengths. Careers. In the immediate postoperative period, the weakest part of any ACLR is the fixation. Recently, we recognized that patients needing ACL reconstruction who also have significant rotatory instability of the knee may have injuries in the anterolateral complex. 8600 Rockville Pike A Meta-analysis of 47,613 Patients. eCollection 2021 Oct-Dec. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. They observed that the the failure rate was 10.3% in the one-stage revision group and 6.1% in the two-stage group. Lee et al. Clipboard, Search History, and several other advanced features are temporarily unavailable. The bone grafting is an opportune time to do an osteotomy to correct the malalignment. performed a CT scan at 4months to assess healing of the bone graft in the tibial tunnel. - figure four flexedpositionassist with providing the best femoral target; Data Trace Publishing Company
a meta-analysis of 32 studies.
ACL reconstruction - Mayo Clinic - Mayo Clinic - Mayo Clinic Franceschi et al. American Journal of Sports Medicine. 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. [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 . femoral tunnel too far anterior in the notch; Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below.
- ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. 2020 Sep;140(9):1211-1219. doi: 10.1007/s00402-020-03421-7. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. Knee Surgery & Related Research Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. There was also a significant improvement in the Lysholm score when comparing preoperative and postoperative values. Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. 2020 Dec 21;9(12):e1917-e1925. - Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. 1998-2023 Mayo Foundation for Medical Education and Research. 110 West Rd., Suite 227
Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. Would you like email updates of new search results? #1. [21] evaluated 88 patients who underwent one-stage revision ACLR. Yoon et al. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. registered for member area and forum access. An Observational Study Using Navigated Measurements Unable to load your collection due to an error, Unable to load your delegates due to an error. Clin Orthop Relat Res. Epub 2018 Dec 17. Clipboard, Search History, and several other advanced features are temporarily unavailable.
What Is the Minimum Length of An Anterior Cruciate Ligament Autograft Tibial tunnel was found to be anterior, perhaps more inferior than would be in an anatomic ACL insertion. 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 A clinical, prospective, randomized, double-blind study. J Knee Surg 17:127132, Mayr R, Rosenberger R, Agraharam D, Smekal V, El Attal R (2012) Revision anterior cruciate ligament reconstruction: an update. 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. 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. Some authors have described the additional use of CT scans to confirm healing at 35months after bone grafting [4, 12, 33, 34]. - anterior graft placement (relative to normal anatomical insertion of ACL) results in high strain on graft as knee is flexed; National Library of Medicine 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. - Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. Am J Sports Med 34:553564, MARS Group, Wright RW, Huston LJ, Spindler KP, Dunn WR, Haas AK et al (2010) Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. Bone tunnel-related issues are frequently encountered during revision anterior cruciate ligament reconstruction. - Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position . Patrick C. McCulloch MD. Sometimes we can perform a biplanar osteotomy to correct both planes of deformity at once. Measurements are made perpendicular to the axial plane of the tunnel at the widest point [15]. 2005 Nov;33(11):1701-9. doi: 10.1177/0363546505276759. 19 Despite favorable outcomes after interference screw fixation, there are concerns related to graft biology, such as graft damage during screw insertion, a small tendon-to-bone contact area for graft integration, the presence of . 1 0 obj
2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. 2017 Jun;99-B(6):714-723. doi: 10.1302/0301-620X.99B6.BJJ-2016-0929.R2. 2013;41:1296. Bone Graft related CPT Codes. Stage II lateral root tear, lateral root repair and repeat revision back-to-back ACL repair. Arthrosc Tech. The mean time between the two stages was 8.8months and in the second stage, bone-biopsy specimens were taken from the tibia. Among these potential scenarios requiring a two-stage revision, tunnel-widening is the most common cause; the first stage involves graft removal, tunnel curettage, and bone grafting, followed by revision ACL reconstruction in the second stage. Similarly, root tears of the lateral meniscus are often missed as well. The https:// ensures that you are connecting to the This video may be inappropriate for some users. Preoperative planning is critical to identify and characterize bone tunnel pathology. JavaScript is disabled. - consider whether there is an interplay between posterior graft placement and appropriate graft tension; statement and
Morphological Changes in the Tibial Tunnel After ACL Reconstruction 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. Failed ACL with Tunnel Enlargement: How I Bone Graft & Stage It Charles H. Brown Jr.,MD Director Abu Dhabi, United Arab Emirates . Franceschi F, Papalia R, Di Martino A, Rizzello G, Allaire R, Denaro V. Arthroscopy. The prior skin incision is typically used to expose the distal portion of the tibial tunnel.
Bone Graft - KarenZupko&Associates, Inc. In theory, the sCO2-sterilized graft only provides osteoconductive properties to the grafted bone tunnels. 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. Bookshelf An Observational Study Using Navigated Measurements. The surgeon submitted CPT code 25431 alone. 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. He is only grafting the bone. Tunnel widening is generally cavitary, frequently maximal in the mid-zone of the tibial tunnel. The new ligament was fixed to the tibia by a metallic screw and to the femur by a bioabsorbable screw. Griffith TB, et al. The two-stage group contained significantly more patients with meniscal and chondral pathology compared with the primary ACLR group. 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]. [38] have reported the outcomes of revision ACLR with and without lateral extra-articular tenodesis. Example: 29888 - ACL Repair G0289 - Arthroscopy, knee, surgical, for removal of loose body, Harvesting and inserting the graft is included in code . endobj
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 ]. We want our patients to be able to return to the activities they enjoy. Is it appropriate to assign codes for both the arthroscopic and open portions of the procedure? 2023 BioMed Central Ltd unless otherwise stated. A common belief of having 20mm of grafts within the femoral tunnel is backed mostly by hearsay rather than scientific proof. stream
Your going to need to get very familiar with 2017 CMS NCCI Surgical Policy Manual. [26] reported the use of a sCO2-sterilized bone allograft to fill tunnel defects as the first stage of a two-stage revision ACLR. - Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction? - this represents the closest reconstitution of the ACL's "physiometry"; (see: isometry); Anterior cruciate ligament (ACL) reconstruction remains the gold-standard treatment for young active patients with functional instability after an ACL injury. One of the main factors associated with tunnel enlargement is malposition of the tibial tunnel, which likely leads to graft micromotion. 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. It may not display this or other websites correctly. 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. sharing sensitive information, make sure youre on a federal Jul 22, 2009. and transmitted securely. A new and innovative procedure. The femoral tunnel was easily visualized with flexing the knee beyond 90 degrees. When measuring with CT, the axial-plane image is considered incorrect because the plane of cuts is inconsistent. It is commonly injured during high-intensity sports. Epub 2018 Feb 23. Title: Slide 1 Author: Charles H Brown Created Date: 12/3/2018 11:52:05 AM . endobj
- most common error is non isometric anterior tunnel placement within intercondylar notch rather than at its normal posterior insertion; Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. 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. Her alignment, tibial slope and cartilage were all normal. in 30 deg flexion at the time of final fixation may result inexcessive graft tension when the knee is position in full extension; 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. A Retrospective Comparative Study. 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. sharing sensitive information, make sure youre on a federal Purpose: Patients were divided into the isolated revision ACLR group (n=45) and the revision ACLR group in combination with ALL reconstruction (n=42). 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? 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.
advocate that the allograft should not be considered as the first choice of graft for revision surgery [36]. 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. The site is secure.
Bone Graft related CPT Codes - eatonhand.com - Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling An official website of the United States government. proprioceptive reflex leading to a functional extension loss while the patient is awake. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. Orthop Clin North Am. Would this qualify for CPT 29888 with a 52 mod? Sorry. Not applicable, this is a review article. 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. For a better experience, please enable JavaScript in your browser before proceeding. Therefore, the coronal and sagittal images (four-tunnel view; femur-coronal, tibia-coronal, femur-sagittal, tibia-sagittal) are primarily used (Fig. 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). 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. Femoral and Tibial Tunnel Bone Grafting for Stage 1 Revision ACL Reconstruction 10,878 views Apr 25, 2017 NewYorkOrtho 25K subscribers Notice. Two-stage revisions are rarely performed, but are particularly useful when addressing substantial tunnel-widening, active infection, and concomitant knee pathology (e.g., malalignment, other ligamentous injuries, meniscal or chondral lesions). Predictors of clinical outcome following revision anterior cruciate ligament reconstruction. J Bone Joint Surg Am 100:9931000, Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. ACL injuries most commonly occur during sports that involve sudden stops and changes in direction such as soccer, football, basketball and volleyball. 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. 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.
Autologous Dedifferentiated Osteogenic Bone Marrow Mesenchymal Stem Hi you mentioned this was a staged procedure - any chance you can post the entire operative report without patient info? Revision anterior cruciate ligament (ACL) reconstruction is becoming more frequent, especially in specialized centers, because of the large numbers of primary ACL procedures performed. Outcomes of repeat revision anterior cruciate ligament reconstruction.
Femoral Tunnel for ACL Reconstruction - Wheeless' Textbook of Orthopaedics Unable to load your collection due to an error, Unable to load your delegates due to an error. Data Trace is the publisher of
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Thomas et al. Few studies report the outcomes of two-stage revision ACLR alone. 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. Rehabilitation after the initial bone-grafting stage shares similarities with standard ACLR protocols [17]. A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction. 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. 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. <>
Morphometric analysis of femoral and tibial tunnel locations revealed that the two procedures were based on the same anatomical concept, and BPTB grafts showed significantly better anterior knee stability than HT grafts, although no significant differences in other objective evaluations and all subjective evaluations were detected between the two graft types in anatomical ACLR. Phys Ther 85:740749, PubMed Spine J 7:475490, Jenis LG, Banco RJ (2010) Efficacy of silicate-substituted calcium phosphate ceramic in posterolateral instrumented lumbar fusion. 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 .
Discover how to save hours each week. 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. Am J Sports Med 40:800807, Article 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). Correlation between femoral tunnel length and tunnel position in ACL reconstruction. Anterior cruciate ligament (ACL) reconstruction rates have increased over the past 20years to roughly 200,000 per year [1]. J Orthop Sci (2010) . Allograft bone grafting femoral an Tibial Tunnels, with Debridement of Tunnels The previous ACL graft was debrided with the use of a shaver. A decision that will often depend on the graft used during the primary ACLR. Trojani et al. - posterior placement or distal to normal site of attachment results in excessive tightening of the graft when knee is extended; If this is your first visit, be sure to check out the. TJ!!X`Sz9Q*BeV={=F ' 0y^*2| '!
Bone Grafting Technique in Revision ACL Reconstruction: Coring Reamer 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. 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. When aperture fixation is not possible, familiarity with, and use of, all-inside tibial and femoral sockets with cortical suspensory fixation may be necessary [4]. Comparison of Femoral Tunnel Position and Clinical Results. Comparison of Femoral Tunnel Position and Clinical Results. BMC Musculoskelet Disord 19:246. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. 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 new technique for femoral and tibial tunnel bone grafting using the Bethesda, MD 20894, Web Policies Our Experience: 2014 - 2018 . 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. Am J Sports Med 36:851860, Franceschi F, Papalia R, Del Buono A, Zampogna B, Diaz Balzani L, Maffulli N et al (2013) Two-stage procedure in anterior cruciate ligament revision surgery: a five-year follow-up prospective study. Ligaments are strong bands of tissue that attach one bone to . 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. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. There are several procedures that can be performed in the ACL revision setting, such as anterolateral ligament reconstruction and iliotibial band tenodesis, to control that rotation. In cases like these your going to need to bill out "what you can" which in this case would be 20680. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. All authors have made substantial contributions to all of the following: (1): the conception and design of the study, (2) drafting the article or revising it critically for important intellectual content, and (3) final approval of the version to be submitted. National Library of Medicine eCollection 2020 Dec. Prall WC, Kusmenkov T, Schmidt B, Frmetz J, Haasters F, Naendrup JH, Bcker W, Shafizadeh S, Mayr HO, Pfeiffer TR. In addition, patients who receive revision ACL surgery might have other damaged ligaments. This site complies with the HONcode standard for trustworthy health information: verify here. He did other procedures, but I have the codes for them. Careers. Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. 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. Accessibility Von recum et al. Enjoy a guided tour of FindACode's many features and tools. There has been a long-standing debate as to whether an autograft or an allograft should be used for revision ACLR. Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. - this technique allows for a more anatomic and precise placement of the femoral tunnel (more reliable posterior placement); government site. registered for member area and forum access. 2015;43:2510. Tunnel orientation and size are the most important causes related to the two-stage procedure, as these enlarged tunnels may complicate graft placement and fixation [11, 12]. But no significant difference was observed between the two groups. TECHNIQUE STEPS. 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. 7 0 obj
HHS Vulnerability Disclosure, Help - Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. - historic techniques: 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. A new harvest site for bone graft in anterior cruciate ligament revision surgery. Samuelsen BT, Webster KE, Johnson NR, Hewett TE, Krych AJ. Recently, a technique for sterilizing musculoskeletal allografts using supercritical carbon dioxide (sCO2) has been developed [26]. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. This is the great debate in ortho coding. I am still awaiting the OP note from the ASC, which takes weeks, so I can't post it. Cancel anytime. 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. Thomas et al. 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.
- this restricts flexion of knee if graft remains intact, or it may elongate graft if the range of motion is restored; [31] used Si-CaP for a bone-graft substitute for tunnel augmentation in two-stage revision ACLR. Methods: 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. MARS Group. (C) Sagittal magnetic resonance imaging showing insufficiency of the anterior cruciate ligament graft. Systematic review. Conclusions. Disclaimer. There are several techniques for bone grafting tunnels in one- or two-staged ACL revision procedures with either autograft or allograft. The slope causes the tibia to move forward and the femur to fall backward, putting tremendous strain on the ACL. Knee-laxity measurements were elevated in the without-revision group, but the difference was not significant. - ref: Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction.