Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? JavaScript is disabled. However, Thomas et al. 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]. However, with precise indications, proper preoperative planning and operative-technique selection, two-stage revision ACLR can achieve favorable outcomes. Anterior cruciate ligament (ACL) reconstruction remains the gold-standard treatment for young active patients with functional instability after an ACL injury. Data extracted included indications for 2-stage surgery, surgical technique, graft material, time between surgeries, rehabilitation protocols, physical examination findings, patient-reported outcomes, and radiographic and histologic findings. View all the articles associated with any code, right from the code page. Please enable it to take advantage of the complete set of features! An official website of the United States government. HHS Vulnerability Disclosure, Help 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. 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. - historic techniques: The https:// ensures that you are connecting to the JFIF C 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. If this is your first visit, be sure to check out the. 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]. Purpose: endstream That would help me to provide some better guidance. 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]. FOIA A 17-year-old female came to see us after two failed ACL surgeries. Guide pins were placed in the tibial tunnel and next putty and dowels (grafts) were placed in the tibial and femoral tunnels. Clinically, many authors have reported good results for two-staged revision ACLR using autograft bone [4, 11]. 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. [33] evaluated 30 patients who underwent two-staged ACLR revision procedure after a traumatic re-rupture of the ACL. Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. 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. 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. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. eCollection 2020 Dec. Prall WC, Kusmenkov T, Schmidt B, Frmetz J, Haasters F, Naendrup JH, Bcker W, Shafizadeh S, Mayr HO, Pfeiffer TR. You are using an out of date browser. 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. Evaluations were performed in the axial plane of the tibia using three parameters (occupying ratio, union ratio, and bone mineral density). -main criticism is that in some cases a transtibial tunnel will not allow for the exact desiredtunnel placement (you get what you get) eCollection 2020 Dec. Lee et al. It does not hit an edit, but be prepared for insurance to deny it. eCollection 2021 Oct-Dec. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. All the patients in the study underwent screw removal and filling of the tunnels with an autograft harvested from the anterior tibial metaphysis. 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]. - Drilling the Femoral Tunnel During ACL Reconstruction: Transtibial Versus Anteromedial Portal Techniques. Discover how to save hours each week. Terms and Conditions, These lesions are often difficult to see on MRI. Ki-Cheor Bae. 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. . To minimize the risk of viral and bacterial contamination, allograft bone is sterilized. official website and that any information you provide is encrypted In active young patients, failed primary ACLR may require a revision ACLR. For assessment of bone-graft incorporation, radiographs are routinely used. 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. For example, patients may require bone grafting of prior graft tunnels, and then have the ACL revision in a second stage. stream - anteromedial portal technique: The authors declare that they have no competing interests. Meniscal tears are another contributing cause. 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). This is the great debate in ortho coding. Spine J 7:475490, Jenis LG, Banco RJ (2010) Efficacy of silicate-substituted calcium phosphate ceramic in posterolateral instrumented lumbar fusion. 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. Tunnel malpositioning and widening remain the most common indications for two-stage revision ACLR. 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. Bookshelf To date, the literature on revision ACLR surgery has primarily focused on comparing the outcomes to those of primary ACLR. - 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. 2022 May 11;11(6):e971-e976. Journal of Orthopaedic Research. Louis et al. and transmitted securely. Epub 2016 Dec 30. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Clin Sports Med 28:203214 vii, Islam A, Chapin K, Moore E, Ford J, Rimnac C, Akkus O (2016) Gamma radiation sterilization reduces the high-cycle fatigue life of allograft bone. 8600 Rockville Pike ",#(7),01444'9=82. Arthroscopy 21:767, Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. - Surgical Technique: Conclusions. Sci Rep (2016) 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. Cookies policy. 2. Uchida et al. Houston Methodist Orthopedics & Sports Medicine. 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. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. American Journal of Sports Medicine. Mayo Clinic has vast experience treating posterior cruciate ligament, lateral collateral ligament, posterolateral and posteromedial corner injuries, as well as medial collateral ligament injuries. 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. eCollection 2021 Dec. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. performed a CT scan at 4months to assess healing of the bone graft in the tibial tunnel. 1 0 obj Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. You are using an out of date browser. Wheeless' Textbook of Orthopaedics. 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. The primary outcome in 2 studies was graft incorporation (mean follow-up, 8.8 months), whereas the other 5 studies reported clinical outcomes with follow-up mean SD of 4.2 2.1 years. Example: 29888 - ACL Repair G0289 - Arthroscopy, knee, surgical, for removal of loose body, Harvesting and inserting the graft is included in code . I just want to get the basic idea so I can advise him since he keeps a copy of his billing. https://doi.org/10.1186/s43019-019-0010-6, DOI: https://doi.org/10.1186/s43019-019-0010-6. doi: 10.1016/j.eats.2020.08.024. 2020 Dec 21;9(12):e1917-e1925. <> Tibial Tunnel Bone Allograft Cpt Code For The. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. 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. However, remarkable advances in knowledge of this process have been made based primarly on animal models. et al. Arthroscopy 33:819827, Diamantopoulos AP, Lorbach O, Paessler HH (2008) Anterior cruciate ligament revision reconstruction: results in 107 patients. Stage I femoral and tibial bone grafting. JavaScript is disabled. 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. 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. doi: 10.1016/j.eats.2021.08.013. Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery. TJ!!X`Sz9Q*BeV={=F ' 0y^*2| '! 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. JavaScript is disabled. Conclusion: They found that a sCO2-sterilized bone allograft showed graft incorporation and remodeling through creeping substitution. eCollection 2022 Jun. [40] reported the results of 87 patients who underwent revision ACLR with a follow-up of more than 3 years. 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. Her alignment, tibial slope and cartilage were all normal. Revision anterior cruciate ligament (ACL) reconstruction is becoming more frequent, especially in specialized centers, because of the large numbers of primary ACL procedures performed. The same is repeated for the tibial tunnel while providing support for the proximal end of the tunnel. 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. Our Experience: 2014 - 2018 . J Orthop Sci (2010) . We thank Eun-Ji Jeon and Min-Ji Kim for their support. 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 A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. The results from this group were compared to the results of a matched group of patients with primary ACLR. - Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. - Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. 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? 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. Secure graft fixation is critical in ensuring a successful two-staged ACLR. CT scans to confirm healing at 3-5months after bone grafting [4, 12, 33, 34]. You must log in or register to reply here. 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. [38] have reported the outcomes of revision ACLR with and without lateral extra-articular tenodesis. 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. CPT codes are grouped into 6 sections: 1. 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 ]. There is no code for bone grafting. CT analysis also included the determination of the filling rates of the tunnels. Autograft was used in 4 studies: iliac crest bone autograft (ICBG, n = 3) and tibial bone autograft (TBA, n = 1). Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. Ramp tears can lead to rotational instability and put excessive strain on the ACL graft, causing it to fail. At Mayo Clinic, we have the imaging, surgical and physical therapy teams to manage extremely complex knee issues. But an iliac-crest autograft is comparatively invasive with relatively high donor-site morbidity and the potential for insufficient yield quantities [11, 22]. Background: Keep your critical coding and billing tools with you no matter where you work. 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. 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. 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. 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. Two-Stage Revision Anterior Cruciate Ligament Reconstruction with Cannulated Allograft Bone Dowels Soaked in Bone Marrow Aspirate Concentrate. 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]. - anterior graft placement (relative to normal anatomical insertion of ACL) results in high strain on graft as knee is flexed; Get timely coding industry updates, webinar notices, product discounts and special offers. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. 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. [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. - under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a 2003 Jan;34(1):49-64. doi: 10.1016/s0030-5898(02)00070-6. Enjoy a guided tour of FindACode's many features and tools. Achieving the correct position can be tricky. Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel. Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. Background: Ligament reconstruction is a common procedure in orthopedic surgery. Physical therapy with muscle-strengthening and proprioceptive training can be performed. - Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. Allograft bone grafting femoral an Tibial Tunnels, with Debridement of Tunnels The previous ACL graft was debrided with the use of a shaver. PMC 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. 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. In theory, the sCO2-sterilized graft only provides osteoconductive properties to the grafted bone tunnels. The initial rehabilitation emphasis is focused on restoring tibiofemoral and patellofemoral passive range of motion, restoring quadriceps activation, and controlling and resolving any joint effusion. This site needs JavaScript to work properly. and transmitted securely. There is ongoing debate about how best to reconstruct the anterior cruciate ligament (ACL) to restore knee kinematics, including which is the best fixation method. Clin Orthop Relat Res. - tunnel positioning: However, many authors prefer using an autograft for revision ACLR when possible. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. Methods: 2020 Sep;140(9):1211-1219. doi: 10.1007/s00402-020-03421-7. Salem HS, Axibal DP, Wolcott ML, et al. Preoperative planning is critical to identify and characterize bone tunnel pathology. It may not display this or other websites correctly. Inferior tendon graft to bone tunnel healing at the tibia compared to that at the femur after anterior cruciate ligament reconstruction. With the rising number of anterior cruciate ligament (ACL) reconstructions, revision ACL reconstructions are becoming increasingly common. They observed that an average 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. Revision ACL surgery: A comprehensive approach. registered for member area and forum access. National Library of Medicine However, the small number of included patients, especially in the group of patients without revision ACLR, is limited. [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. Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. 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. Outcomes of repeat revision anterior cruciate ligament reconstruction. Bone Graft related CPT Codes. You must log in or register to reply here. Keywords: Phys Ther 85:740749, PubMed TECHNIQUE STEPS. Franceschi et al. 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. 2015;43:2510. 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. 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. <> $.' Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. <> Background: No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. The indication for bone grafting and between-stage protocol varied among studies. Unable to load your collection due to an error, Unable to load your delegates due to an error. Am J Sports Med 38:19791986, Dye SF (1996) The future of anterior cruciate ligament restoration. The bone grafting is an opportune time to do an osteotomy to correct the malalignment. %PDF-1.5 1). - references: Arthrosc Tech. Mayo Clinic has substantial experience with all of these procedures. Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. 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]. Thomas et al. Bethesda, MD 20894, Web Policies Kim, DH., Bae, KC., Kim, DW. One of the main factors associated with tunnel enlargement is malposition of the tibial tunnel, which likely leads to graft micromotion. This adds a fair amount of complexity to the procedure. Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. eCollection 2022 Jul. statement and He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. There was also a significant improvement in the Lysholm score when comparing preoperative and postoperative values. The two-stage group contained significantly more patients with meniscal and chondral pathology compared with the primary ACLR group. 2020;38:1191. Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. - A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction Am J Sports Med 47:324333, Chmielewski TL, Hurd WJ, Rudolph KS, Axe MJ, Snyder-Mackler L (2005) Perturbation training improves knee kinematics and reduces muscle co-contraction after complete unilateral anterior cruciate ligament rupture. Is it appropriate to assign codes for both the arthroscopic and open portions of the procedure? doi: 10.2106/JBJS.ST.20.00055. Van de pol et al. 2002 Richard O'Connor Award paper. 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. This provides a cylindrical graft, which is delivered to the femoral tunnel through the arthroscopic portal. Sometimes we can perform a biplanar osteotomy to correct both planes of deformity at once. - one incision transtibialtechnique <>>> Two-stage revision anterior cruciate ligament reconstruction. J Bone Joint Surg Br 89:10511054, Article Epub 2018 Feb 23. 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). The new ligament was fixed to the tibia by a metallic screw and to the femur by a bioabsorbable screw. endobj 2005 Nov;33(11):1701-9. doi: 10.1177/0363546505276759. At Mayo Clinic, we sometimes correct the alignment before performing revision ACL surgery, to prevent graft failure. - Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. 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. 2022 Feb 28;11(3):e463-e469. Pre-op imaging shows excessive tunnel and socket widening and no malalignment with normal slope. 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]. 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. xMO@; aK]XDZ)r(-w(;.B ~8MG{ - ref: Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. Towson, MD 21204 2017 Apr;33(4):819-827. doi: 10.1016/j.arthro.2016.10.007. By using this website, you agree to our 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.