doi: 10.2106/JBJS.ST.20.00055. For a better experience, please enable JavaScript in your browser before proceeding. 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. Houston Methodist Orthopedics & Sports Medicine. Bone Tunnel Management in Modern Revision Anterior Cruciate Ligament A relatively small but challenging subset of patients requires two-stage revision ACLR. The femoral tunnel was a little high. Bone tunnel-related issues are frequently encountered during revision anterior cruciate ligament reconstruction. Staged ACL Revision | Medical Billing and Coding Forum - AAPC Griffith TB, et al. 8 Therefore, one should avoid angles <40 to 45 . 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. It is commonly injured during high-intensity sports. They observed that the the failure rate was 10.3% in the one-stage revision group and 6.1% in the two-stage group. He did other procedures, but I have the codes for them. No, I'm sorry that was my bad, you did say allograft, I just overlooked it. Several Mayo Clinic orthopedic surgeons are members of the Multicenter ACL Revision Study (MARS) Group, which has authored a series of reports on topics including predictors of clinical outcomes, published in Journal of Orthopaedic Research in 2020. Study design: The goal of revision ACLR is to improve knee stability and activity levels, but the outcomes are reported to be inferior to those of primary ACLR [3]. 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 Please enable it to take advantage of the complete set of features! Jul 22, 2009. The indications for staged ACL reconstruction and the rehabilitation protocol between stages need to be clearly established. Bookshelf ACL reconstruction - Mayo Clinic - Mayo Clinic - Mayo Clinic This is the great debate in ortho coding. All rights reserved. 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. Arthroscopic Delivery of Injectable Bone Graft for Staged Revision The .gov means its official. Epub 2005 Aug 10. Epub 2018 Feb 23. JCM | Free Full-Text | Femoral Tunnel Position Affects Postoperative CT scans to confirm healing at 3-5months after bone grafting [4, 12, 33, 34]. California Privacy Statement, 2020 Sep;140(9):1211-1219. doi: 10.1007/s00402-020-03421-7. -notchplasty This provides a cylindrical graft, which is delivered to the femoral tunnel through the arthroscopic portal. - Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position . Grassi A, Nitri M, Moulton SG, Marcheggiani Muccioli GM, Bondi A, Romagnoli M, Zaffagnini S. Bone Joint J. Knee-laxity measurements were elevated in the without-revision group, but the difference was not significant. anterior cruciate ligament; bone graft; knee; revision. official website and that any information you provide is encrypted 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. A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction. An Observational Study Using Navigated Measurements new ACL graft. We routinely obtain hip-to-ankle AP X-rays to assess for any coronal plane malalignment. "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. While one-stage revision ACLR is well described and reported, few studies have reported the outcomes of two-stage revision ACLR. - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. Von recum et al. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Cite this article. Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. Drilling the Femoral Tunnel During ACL Reconstruction: Transtibial Versus Anteromedial Portal Techniques. It may not display this or other websites correctly. Orthop Traumatol Surg Res 103:S223S2S9, Lee DW, Kim JG, Cho SI, Kim DH (2019) Clinical outcomes of isolated revision anterior cruciate ligament reconstruction or in combination with anatomic anterolateral ligament reconstruction. %PDF-1.5 Primary ACL reconstruction is recognized as a successful procedure, but failure has been shown to occur in approximately 10% of patients. I just want to get the basic idea so I can advise him since he keeps a copy of his billing. Bone Grafting tibial and femoral tunnels knee, failed ACL - posterior placement or distal to normal site of attachment results in excessive tightening of the graft when knee is extended; 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. [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 . The authors declare that they have no competing interests. This process is repeated until there is full fill of femoral tunnel. Bruce A. 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. The mean time between the two stages was 8.8months and in the second stage, bone-biopsy specimens were taken from the tibia. 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). Google Scholar, Mitchell JJ, Chahla J, Dean CS, Cinque M, Matheny LM, LaPrade RF (2017) Outcomes after 1-stage versus 2-stage revision anterior cruciate ligament reconstruction. Article | Outpatient Surgery Magazine - Association of periOperative TECHNIQUE VIDEO. Thomas et al. Patient age and activity level are also important factors when deciding on graft choice for revision procedures. Towson, MD 21204 Arthrosc Tech. A Retrospective Comparative Study. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. Arthroscopy 21:767, Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. Careers. JFIF C Discover how to save hours each week. 2013;41:1296. endstream Arthroscopic Delivery of Injectable Bone Graft for Staged Revision 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 . 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. - over the top repair tensioned in extension will provide support in terminal extension but may slacken at greater flexion angles; Knee Surgery & Related Research ACL Reconstruction with a Bone-Patellar Tendon-Bone (BPTB) Graft Inferior tendon graft to bone tunnel healing at the tibia compared to that at the femur after anterior cruciate ligament reconstruction. Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. statement and Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Revision ACL surgery: A comprehensive approach - Mayo Clinic To minimize the risk of viral and bacterial contamination, allograft bone is sterilized. - tunnel positioning: <> Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. 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]. Am J Sports Med 38:19791986, Dye SF (1996) The future of anterior cruciate ligament restoration. Arthrosc Tech. At a mean period of 33.9months, there was an improvement in the Lysholm score (77.215.5 vs 72.918.7), IKDC score (69.013.4 vs 69.313.4) and Tegner activity score (4.11.5 vs 4.61.2) for both groups. The two-stage group contained significantly more patients with meniscal and chondral pathology compared with the primary ACLR group. a statistical evaluation. The same is repeated for the tibial tunnel while providing support for the proximal end of the tunnel. [43] reported the results of 54 patients who underwent bone grafting due to recurrent, symptomatic ACL deficiency following ACLR. performed a CT scan at 4months to assess healing of the bone graft in the tibial tunnel. 2005 Nov;33(11):1701-9. doi: 10.1177/0363546505276759. Accessibility They observed that an average 2021 Oct 12;11(4):e20.00055. Please enable it to take advantage of the complete set of features! Comparison of Femoral Tunnel Position and Clinical Results. Biazzo A, Manzotti A, Motavalli K, Confalonieri N. J Clin Orthop Trauma. Achieving the correct position can be tricky. 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. In cases like these your going to need to bill out "what you can" which in this case would be 20680. Biomechanical Comparison Between Bashti Bone Plug Technique and 2 0 obj Battaglia and Miller [12] indicated that bone grafting should be performed in cases with a tunnel diameter of 1015mm. Disclaimer. Tibial Tunnel Bone Allograft Cpt - toyoulalar He is only grafting the bone. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. Unless the surgeon looks specifically for a ramp lesion at the time of ACL surgery, the lesion can be missed. - Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. in 30 deg flexion at the time of final fixation may result inexcessive graft tension when the knee is position in full extension; JavaScript is disabled. 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. Springer Nature. 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]. Secure graft fixation is critical in ensuring a successful two-staged ACLR. 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]. - this represents the closest reconstitution of the ACL's "physiometry"; (see: isometry); Tunnel malpositioning and widening remain the most common indications for two-stage revision ACLR. 1). The analysis included 7 studies with a total of 234 patients. They observed that an average of 5.8months was needed for healing of the autograft dowel to become visible on CT scans [11]. registered for member area and forum access. Tunnel widening is generally cavitary, frequently maximal in the mid-zone of the tibial tunnel. Keywords: - Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling 2021 Oct 12;11(4):e20.00055. - figure four flexedpositionassist with providing the best femoral target; 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. 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). % doi: 10.1016/j.eats.2020.08.024. The optimal and earliest possible timing of the two-stage procedure is still not clear. 110 West Rd., Suite 227 Enhancement of tendon-to-bone healing after anterior cruciate ligament reconstruction using bone marrow-derived mesenchymal stem cells genetically modified with bFGF/BMP2. Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. doi: 10.1016/j.eats.2021.11.019. [21] evaluated 88 patients who underwent one-stage revision ACLR. Allograft bone grafting femoral an Tibial Tunnels, with Debridement of Tunnels The previous ACL graft was debrided with the use of a shaver. Bone Grafting Technique in Revision ACL Reconstruction: Coring Reamer 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. 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. xMO@; aK]XDZ)r(-w(;.B ~8MG{ However, with precise indications, proper preoperative planning and operative-technique selection, two-stage revision ACLR can achieve favorable outcomes. 7 0 obj Hi you mentioned this was a staged procedure - any chance you can post the entire operative report without patient info? [40] reported the results of 87 patients who underwent revision ACLR with a follow-up of more than 3 years. 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]. Enjoy a guided tour of FindACode's many features and tools. volume31, Articlenumber:10 (2019) The greater the tibial slope, the higher the risk of graft failure as our group found in a 2015 study in American Journal of Sports Medicine. Two-stage revision ACLR should be considered in cases of tunnel lysis, infection, malalignment, meniscal deficiency, or chondral lesions. The bone graft is deployed, and plunger can be used to gently pack graft into tunnel. Bone graft substitute for tunnel filling improved ACL reconstruction Rehabilitation after the initial bone-grafting stage shares similarities with standard ACLR protocols [17]. Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) using bone-tendon-bone (BTB) autograft is associated with increased postoperative anterior knee pain and pain with kneeling and has the risk of intra- and postoperative patellar fracture. - ACL position is lower and more horizontal than that achieved when performing the transtibial (TT) procedure. https://doi.org/10.1186/s43019-019-0010-6, DOI: https://doi.org/10.1186/s43019-019-0010-6. Arthrosc Tech. doi: 10.1016/j.eats.2021.08.013. 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? Data Trace Publishing Company Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. Two-stage revision anterior cruciate ligament reconstruction: a systematic review of bone graft options for tunnel augmentation. 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]. Privacy They reported that Si-CaP as a bone-graft substitute for tunnel augmentation showed favorable histologic, radiologic, and intraoperative integration comparable to the autologous iliac bone graft. Accessibility 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]. J Bone Joint Surg Am 100:9931000, Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. Stage II lateral root tear, lateral root repair and repeat revision back-to-back ACL repair. Tibial tunnel was found to be anterior, perhaps more inferior than would be in an anatomic ACL insertion. Unless you probe for a root tear during surgery, you may miss it. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. Your going to need to get very familiar with 2017 CMS NCCI Surgical Policy Manual. A Meta-analysis of 47,613 Patients. Clifford R. Wheeless, III, M.D. registered for member area and forum access. Am J Sports Med 45:17901798, Diermeier T, Herbst E, Braun S, Saracuz E, Voss A, Imhoff AB et al (2018) Outcomes after bone grafting in patients with and without ACL revision surgery: a retrospective study. - under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a That would help me to provide some better guidance. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. Only 44 patients underwent a staged revision ACLR after bone grafting and 10 patients refused to undergo a revision ACLR. Noyes et al. Methods: The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Few studies report the outcomes of two-stage revision ACLR alone. Correspondence to - Anteromedial Portal vs Transtibial Drilling Techniques in Anterior Cruciate Ligament Reconstruction: Any Clinical Relevance? Bone and Joint Clinic. - graft that tightens (pulls up into the tibial tunnel) with flexion will have a much higher likelyhood offailure and usually indicates a There is no code for bone grafting. Sorry. Postoperatively, no complications were reported and none of the included patients had a flexion or extension deficit. Arthrosc Tech. If this is your first visit, be sure to check out the. J Bone Joint Surg Br 89:10511054, Article eCollection 2020 Dec. Diermeier et al. - surgeon will also note more perpendicular drill angle to bone surface with AM vs TransTibial drilling; Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. Bone grafting of femur and tibial tunnels - AHA Coding Clinic for HCPCS 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. When measuring with CT, the axial-plane image is considered incorrect because the plane of cuts is inconsistent. 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. Mayo Clinic is a not-for-profit organization. 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. J Orthop Sci (2010) . 2020;38:1191. 2002 Richard O'Connor Award paper. 2020;48(3):767-777. Surgery is often recommended to restore knee strength and function by reconstructing a damaged ACL with a graft. Overview. Franceschi F, Papalia R, Di Martino A, Rizzello G, Allaire R, Denaro V. Arthroscopy. Unauthorized use of these marks is strictly prohibited. Bone Graft related CPT Codes. They found that a sCO2-sterilized bone allograft showed graft incorporation and remodeling through creeping substitution. - The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint Louis et al. 6 0 obj eCollection 2020 Dec. Prall WC, Kusmenkov T, Schmidt B, Frmetz J, Haasters F, Naendrup JH, Bcker W, Shafizadeh S, Mayr HO, Pfeiffer TR. 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). Two-Stage Revision Anterior Cruciate Ligament Reconstruction with Cannulated Allograft Bone Dowels Soaked in Bone Marrow Aspirate Concentrate. endobj 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]. Recently, we recognized that patients needing ACL reconstruction who also have significant rotatory instability of the knee may have injuries in the anterolateral complex. and transmitted securely. Provided by the Springer Nature SharedIt content-sharing initiative. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. 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. Radiographic evaluation of bone graft integration after the first stage was reported in 4 studies, with an average duration of 4.9 months. Get timely coding industry updates, webinar notices, product discounts and special offers. . For a better experience, please enable JavaScript in your browser before proceeding. 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 . Sometimes we can perform a biplanar osteotomy to correct both planes of deformity at once. Clin Orthop Relat Res. 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. Not applicable, this is a review article. HHS Vulnerability Disclosure, Help The surgeon submitted CPT code 25431 alone. Results: Coronal (a) and sagittal (b) view of computed tomography (CT) images demonstrate widening of the tibial tunnel in the setting of a failed anterior cruciate ligament reconstruction. - references: Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. (A, B) Anteroposterior and lateral knee radiographs showing bone tunnel positioning, widening, and retained biocomposite screw. You must log in or register to reply here. [26] reported the use of a sCO2-sterilized bone allograft to fill tunnel defects as the first stage of a two-stage revision ACLR. Revision ACL surgery: A comprehensive approach. View all the articles associated with any code, right from the code page. It may not display this or other websites correctly. - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. eCollection 2022 Jun. Two years after the surgery, she resumed all activities and plays collegiate volleyball. - references: This site complies with the HONcode standard for trustworthy health information: verify here. ]+yC`6Hd Ql]M 3w7ah;HNdyS*7x-zq^/4%^6eA$m@(,ly}U[N9E(/=iHCL")d6yx]K7!84,q!r~#6mE8dIS69eYn Autograft bone, either from the iliac crest or anterior tibial plateau, is still considered the gold standard source for grafting because of its osteoconductive, osteoinductive, and osteogenic properties. - Discussion: Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. I forgot to mention he did an allograft bone graft. CAS You are using an out of date browser. This adds a fair amount of complexity to the procedure. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. Uchida et al. 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]. See our privacy policy. Although there are many proposed theories for tunnel lysis, it is most accurate to state that this condition has a multifactorial origin; mechanical and biologic causes have been reported, and both contribute to enlarged graft tunnels [11, 13]. doi: 10.1016/j.arthro.2006.07.054. - two incision technique (outside in) - ACL graft should pull up intotibial tunnel by about 2mm with extension when fixed on femoral side; J Knee Surg 17:127132, Mayr R, Rosenberger R, Agraharam D, Smekal V, El Attal R (2012) Revision anterior cruciate ligament reconstruction: an update. sharing sensitive information, make sure youre on a federal endobj 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 results from this group were compared to the results of a matched group of patients with primary ACLR. Morphological Changes in the Tibial Tunnel After ACL Reconstruction Tibial tunnel cyst | Radiology Reference Article | Radiopaedia.org Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery. In the immediate postoperative period, the weakest part of any ACLR is the fixation. 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?

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