A Retrospective Comparative Study. Diermeier et al. 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 . Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. [38] have reported the outcomes of revision ACLR with and without lateral extra-articular tenodesis. Von recum et al. The patients were divided into two groups based on the tunnel diameter (group A, <12mm; group B, <12mm). You are using an out of date browser. Hello, our physician bone grafted the previous ACL tunnels with allograft via arthroscopy. For example, patients may require bone grafting of prior graft tunnels, and then have the ACL revision in a second stage. 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. 2002 Richard O'Connor Award paper. In 2 studies, the authors investigated the outcomes of allograft: allograft bone matrix (ABM) and allograft bone chips (AC). An average Lysholm score at 2 years post operation was 96.6 points 2.1 (91100 points). Am J Sports Med. Wheeless' Textbook of Orthopaedics. - consider whether there is an interplay between posterior graft placement and appropriate graft tension; 110 West Rd., Suite 227 This content does not have an Arabic version. . Epub 2018 Dec 17. 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. 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 doi: 10.1016/j.eats.2021.11.019. Excessive tibial slope also puts patients at much higher risk of early ACL reconstruction failure. Surgery is often recommended to restore knee strength and function by reconstructing a damaged ACL with a graft. Keywords: 2002 Richard O'Connor Award paper. The analysis included 7 studies with a total of 234 patients. Before 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. J Orthop Sci (2010) . Tunnel malpositioning and widening remain the most common indications for two-stage revision ACLR. Would this qualify for CPT 29888 with a 52 mod? 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. The anterior cruciate ligament (ACL) is a ligament that provides stability to the knee joint. PubMedGoogle Scholar. 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. Autograft was used in 4 studies: iliac crest bone autograft (ICBG, n = 3) and tibial bone autograft (TBA, n = 1). - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. Conclusion: Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction? 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. 5 0 obj See our privacy policy. The slope causes the tibia to move forward and the femur to fall backward, putting tremendous strain on the ACL. The inside punch of the harvester is tapped and this allows delivery of the graft in a controlled manner and its impaction into the tunnel. Stage I femoral and tibial bone grafting. In cases like these your going to need to bill out "what you can" which in this case would be 20680. We thank Eun-Ji Jeon and Min-Ji Kim for their support. and transmitted securely. official website and that any information you provide is encrypted Thomas et al. Enhancement of tendon-to-bone healing after anterior cruciate ligament reconstruction using bone marrow-derived mesenchymal stem cells genetically modified with bFGF/BMP2. - anterior graft placement (relative to normal anatomical insertion of ACL) results in high strain on graft as knee is flexed; doi: 10.1016/j.eats.2022.03.024. 2020;38:1191. 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]. To me it really is a separate issue especially since the debridement was performed first, not as a clean up after the hardware was removed. <> The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). -notchplasty Example: 29888 - ACL Repair G0289 - Arthroscopy, knee, surgical, for removal of loose body, Harvesting and inserting the graft is included in code . Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. 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. The site is secure. Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. - ACL position is lower and more horizontal than that achieved when performing the transtibial (TT) procedure. Telephone: 410.494.4994, Morphology of the Femoral Intercondylar Notch, The Lateral Intercondylar RidgeA Key to Anatomic Anterior Cruciate Ligament Reconstruction. anterior cruciate ligament; bone graft; knee; revision. Comparison of Femoral Tunnel Position and Clinical Results. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. Two-Stage Revision Anterior Cruciate Ligament Reconstruction with Cannulated Allograft Bone Dowels Soaked in Bone Marrow Aspirate Concentrate. At a mean follow-up of 7.9years, clinical scores following revision ACLR did not differ significantly according to the tunnel size. 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. 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. Title: Slide 1 Author: Charles H Brown Created Date: 12/3/2018 11:52:05 AM . 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]. Systematic review. 3. Arthroscopic knee procedure CPT codes range from 29866 to 29889. proprioceptive reflex leading to a functional extension loss while the patient is awake. The bone grafting is an opportune time to do an osteotomy to correct the malalignment. advocate that the allograft should not be considered as the first choice of graft for revision surgery [36]. 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). 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. When performing a revision reconstruction, the surgeon decides between a single-stage or a two-stage revision. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. It may not display this or other websites correctly. What other specialized procedures might be performed in conjunction with ACL revision surgery? ",#(7),01444'9=82. 8 Therefore, one should avoid angles <40 to 45 . CAS Would you like email updates of new search results? A clinical, prospective, randomized, double-blind study. Manage cookies/Do not sell my data we use in the preference centre. Meniscal tears are another contributing cause. - Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. Sci Rep (2016) Correlation between femoral tunnel length and tunnel position in ACL reconstruction. Similarly, root tears of the lateral meniscus are often missed as well. Abstract The . Careers. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. Houston Methodist Orthopedics & Sports Medicine. Study design: Systematic review. Measurements are made perpendicular to the axial plane of the tunnel at the widest point [15]. All rights reserved. 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. A total 75 patients (75 knees) who underwent ACL reconstruction with tibialis anterior allografts were investigated between February 2015 and October . No, I'm sorry that was my bad, you did say allograft, I just overlooked it. A 17-year-old female came to see us after two failed ACL surgeries. 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. Springer Nature. 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. Then in that case, yes, I would code this as 29888-52. 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]. % I would look at billing 29877 for the debridement of the soft tissue. A common belief of having 20mm of grafts within the femoral tunnel is backed mostly by hearsay rather than scientific proof. Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. Terms and Conditions, -allows the femoral attachment point to overlap the anterolateral and posteromedial bundles insertion site A single copy of these materials may be reprinted for noncommercial personal use only. My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. -main criticism is that in some cases a transtibial tunnel will not allow for the exact desiredtunnel placement (you get what you get) Background: No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. There is no code for bone grafting. MeSH Inferior tendon graft to bone tunnel healing at the tibia compared to that at the femur after anterior cruciate ligament reconstruction. Not applicable, this is a review article. Drilling a tibial tunnel at 40 degrees yields an average tunnel length of 45.442.18 mm. Bone Grafting Tibial and Femoral Tunnels knee Portion of op note reads as follows: ACL was completely absent in mid aspect. To minimize the risk of viral and bacterial contamination, allograft bone is sterilized. Some authors have described the additional use of CT scans to confirm healing at 35months after bone grafting [4, 12, 33, 34]. 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]. The tibial tunnel looked to be in a good position. - this represents the closest reconstitution of the ACL's "physiometry"; (see: isometry); statement and 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. #1. - The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint Does the type of graft affect the outcome of revision anterior cruciate ligament reconstruction? Bone tunnel-related issues are frequently encountered during revision anterior cruciate ligament reconstruction. 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. Allograft bone grafting femoral an Tibial Tunnels, with Debridement of Tunnels The previous ACL graft was debrided with the use of a shaver. 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. You must log in or register to reply here. - Anatomic femoral tunnel drilling in anterior cruciate ligament reconstruction: use of an accessory medial portal versus traditional transtibial drilling Clipboard, Search History, and several other advanced features are temporarily unavailable. Radiographic evaluation of bone graft integration after the first stage was reported in 4 studies, with an average duration of 4.9 months. Journal of Orthopaedic Research. 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 ]. Preoperative planning is critical to identify and characterize bone tunnel pathology. Increasing expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions require precise knowledge of technical details such as minimum intra-femoral tunnel graft lengths. Background: Only 44 patients underwent a staged revision ACLR after bone grafting and 10 patients refused to undergo a revision ACLR. Accessibility Uchida et al. Franceschi et al. Tibial Tunnel Bone Allograft Cpt Code For The. In addition, patients who receive revision ACL surgery might have other damaged ligaments. 7 0 obj 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. 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. Bone Grafting Technique in Revision ACL Reconstruction: Coring Reamer and Dowel Trick. 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. Epub 2020 Apr 1. FOIA Arthrosc Tech. An Observational Study Using Navigated Measurements. 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. Phys Ther 85:740749, PubMed Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. 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. - figure four flexedpositionassist with providing the best femoral target; He did other procedures, but I have the codes for them. California Privacy Statement, Am J Sports Med 42:23012310, Noyes FR, Barber-Westin SD, Roberts CS (1994) Use of allografts after failed treatment of rupture of the anterior cruciate ligament. xMO@; aK]XDZ)r(-w(;.B ~8MG{ Orthop Clin North Am. The mean time between the two stages was 8.8months and in the second stage, bone-biopsy specimens were taken from the tibia. However, Thomas et al. In addition, we obtain single leg knee-to-ankle lateral X-rays to assess for any sagittal plane malalignment as well as to look for excessive tibial slope. 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]. It does not hit an edit, but be prepared for insurance to deny it. All the patients in the study underwent screw removal and filling of the tunnels with an autograft harvested from the anterior tibial metaphysis. Improved muscle strength may be the decisive factor; however, changes in functional movement patterns after intensive physical therapy are also important to consider [41]. Guide pins were placed in the tibial tunnel and next putty and dowels (grafts) were placed in the tibial and femoral tunnels. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. - Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. An official website of the United States government. Epub 2016 Dec 30. Uchida et al. Root tears also put tremendous forces on the ACL graft and can lead to rotational instability and graft failure. - resulting anterior-posterior cruciate ligament impingement near extension caused a persistentfunctional extension deficit of 20; 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 . - graft that tightens (pulls up into the tibial tunnel) with flexion will have a much higher likelyhood offailure and usually indicates a This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. Keep your critical coding and billing tools with you no matter where you work. 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. Mayo Clinic has substantial experience with all of these procedures. 8600 Rockville Pike Noyes et al. Tunnel widening is generally cavitary, frequently maximal in the mid-zone of the tibial tunnel. I just want to get the basic idea so I can advise him since he keeps a copy of his billing. - this technique allows for a more anatomic and precise placement of the femoral tunnel (more reliable posterior placement); - this restricts flexion of knee if graft remains intact, or it may elongate graft if the range of motion is restored; Si-CaP appears to provide a more stable osteoconductive scaffold to support faster angiogenesis. 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. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. This video may be inappropriate for some users. TJ!!X`Sz9Q*BeV={=F ' 0y^*2| '! government site. Our Experience: 2014 - 2018 . - references: No charge. However, the small number of included patients, especially in the group of patients without revision ACLR, is limited. 2017 Oct;475(10):2459-2468. doi: 10.1007/s11999-017-5278-9. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. By using this website, you agree to our The optimal and earliest possible timing of the two-stage procedure is still not clear. No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. endobj 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? Secure graft fixation is critical in ensuring a successful two-staged ACLR. TECHNIQUE STEPS. Overview. Lee et al. - Anteromedial Portal vs Transtibial Drilling Techniques in Anterior Cruciate Ligament Reconstruction: Any Clinical Relevance? Knee-laxity measurements were elevated in the without-revision group, but the difference was not significant. $.' 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. Ramp tears can lead to rotational instability and put excessive strain on the ACL graft, causing it to fail. endstream 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. 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. ACL reconstruction is surgery to replace a torn anterior cruciate (KROO-she-ate) ligament (ACL) a major ligament in your knee. 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. 2020 Dec 21;9(12):e1917-e1925. A new and innovative procedure. doi: 10.1016/j.eats.2022.01.004. Hi you mentioned this was a staged procedure - any chance you can post the entire operative report without patient info? 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]. A tamp is used to further compress the graft. 2013;41:1296. Rehabilitation after the initial bone-grafting stage shares similarities with standard ACLR protocols [17]. - Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. They observed that an average Data Trace is the publisher of - over the top position: For the aforementioned reasons, in this review, we will provide an overview of two-stage revision ACLR in the following order: preoperative planning, surgical considerations, rehabilitation, outcomes, and conclusions. Arthroscopic Revision of Attenuated Anterior Cruciate Ligament Graft With Enlarged Bone Tunnels Using Injectable Bone Graft Substitute. Recently, we recognized that patients needing ACL reconstruction who also have significant rotatory instability of the knee may have injuries in the anterolateral complex. 2022 Jun 21;11(7):e1367-e1372. 1). Revision ACL graft failure rates were reported by 5 studies, including 1 study with ABM (6.1%), 1 study with AC (8.3%), 1 study with TBA (0%), and 2 studies with ICBG (0% and 2%). The https:// ensures that you are connecting to the BMC Musculoskelet Disord 19:246. 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. Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. Van de pol et al. In theory, the sCO2-sterilized graft only provides osteoconductive properties to the grafted bone tunnels. Clifford R. Wheeless, III, M.D. Remaining soft tissue was debrided along tibia. 8600 Rockville Pike The surgeon submitted CPT code 25431 alone. Yoon et al. 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. - makesure that interference screws are less than 25 mm in length; No restrictions are placed on their range of motion and patients were allowed to weightbear on the affected leg using crutches [17]. Bookshelf Effects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft. HHS Vulnerability Disclosure, Help 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? 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. Pre-op imaging shows excessive tunnel and socket widening and no malalignment with normal slope. Additionally, graft-tunnel mismatch is problematic, often leading to inadequate osseous . eCollection 2020 Dec. Methods: Am J Sports Med 40:800807, Article It is commonly injured during high-intensity sports. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. 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]. - under anesthesia, the extension loss diminished, and thus it was hypothesized that the ACL-PCL impingement during extension activates a - over the top repair tensioned in extension will provide support in terminal extension but may slacken at greater flexion angles; Towson, MD 21204 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. At Mayo Clinic, we sometimes correct the alignment before performing revision ACL surgery, to prevent graft failure. 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.
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