bone graft acl tunnel cpt bone graft acl tunnel cpt

Background: No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. Houston Methodist Orthopedics & Sports Medicine. Ki-Cheor Bae. 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. 2020 Dec 21;9(12):e1917-e1925. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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. Clifford R. Wheeless, III, M.D. The mean time between the two stages was 8.8months and in the second stage, bone-biopsy specimens were taken from the tibia. 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. Neil Duplantier MD. -allows the femoral attachment point to overlap the anterolateral and posteromedial bundles insertion site registered for member area and forum access. registered for member area and forum access. 2021 Oct 12;11(4):e20.00055. Mayo Clinic is a not-for-profit organization. Study design: Systematic review. 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. 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. Unauthorized use of these marks is strictly prohibited. - lateral tunnel placement: Trojani et al. 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. 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? 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]. A common belief of having 20mm of grafts within the femoral tunnel is backed mostly by hearsay rather than scientific proof. The .gov means its official. eCollection 2022 Mar. Sometimes we can perform a biplanar osteotomy to correct both planes of deformity at once. Department of Orthopaedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, 1035 Dalgubul-ro, Dalseo-gu, Daegu, 42601, South Korea, Du-Han Kim,Ki-Cheor Bae,Dong-Wan Kim&Byung-Chan Choi, You can also search for this author in You are using an out of date browser. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. Excessive tibial slope also puts patients at much higher risk of early ACL reconstruction failure. When measuring with CT, the axial-plane image is considered incorrect because the plane of cuts is inconsistent. I just want to get the basic idea so I can advise him since he keeps a copy of his billing. Philippe C, Marot V, Courtot L, Mesnier T, Reina N, Cavaignac E. Arthrosc Tech. Correlation between femoral tunnel length and tunnel position in ACL reconstruction. Drilling a tibial tunnel at 40 degrees yields an average tunnel length of 45.442.18 mm. - references: ACL Reconstruction with a Bone-Patellar Tendon-Bone (BPTB) Graft The analysis included 7 studies with a total of 234 patients. The same is repeated for the tibial tunnel while providing support for the proximal end of the tunnel. Pre-op imaging shows excessive tunnel and socket widening and no malalignment with normal slope. Results: TECHNIQUE VIDEO. Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. - figure four flexedpositionassist with providing the best femoral target; In the immediate postoperative period, the weakest part of any ACLR is the fixation. 2021 Oct 12;11(4):e20.00055. Background: Ligament reconstruction is a common procedure in orthopedic 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. Patients were divided into the isolated revision ACLR group (n=45) and the revision ACLR group in combination with ALL reconstruction (n=42). Optimal outcomes require a precise picture of how the ACL reconstruction failed. - Reflex extension loss afteranterior cruciate ligamentreconstruction due to femoral "high noon" graft placement. The site is secure. Cite this article. Abstract The . 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. - Anteromedial Portal vs Transtibial Drilling Techniques in Anterior Cruciate Ligament Reconstruction: Any Clinical Relevance? What Is the Minimum Length of An Anterior Cruciate Ligament Autograft - most common error is non isometric anterior tunnel placement within intercondylar notch rather than at its normal posterior insertion; - in the report byStrobel MJ, et al., the authors report a case of a painful reflex extension loss due tofemoral malplacement of anACLgraft in a female high-level athlete; At Mayo Clinic, we sometimes correct the alignment before performing revision ACL surgery, to prevent graft failure. We routinely obtain hip-to-ankle AP X-rays to assess for any coronal plane malalignment. Native Anterior Cruciate Ligament Obliquity Versus Anterior Cruciate Ligament Graft Obliquity. 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. 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. doi: 10.1016/j.eats.2021.08.013. But no significant difference was observed between the two groups. Stage II lateral root tear, lateral root repair and repeat revision back-to-back ACL repair. Rehabilitation after the initial bone-grafting stage shares similarities with standard ACLR protocols [17]. 2. BMC Musculoskelet Disord 19:246. - ACL position is lower and more horizontal than that achieved when performing the transtibial (TT) procedure. doi: 10.1016/j.eats.2020.08.024. doi: 10.1016/j.eats.2020.08.024. This is the great debate in ortho coding. Arthroscopy 33:819827, Diamantopoulos AP, Lorbach O, Paessler HH (2008) Anterior cruciate ligament revision reconstruction: results in 107 patients. Bone Graft related CPT Codes. advocate that the allograft should not be considered as the first choice of graft for revision surgery [36]. Bethesda, MD 20894, Web Policies Mayo Clinic has substantial experience with all of these procedures. You are using an out of date browser. Revision anterior cruciate ligament (ACL) reconstruction is becoming more frequent, especially in specialized centers, because of the large numbers of primary ACL procedures performed. Blurring of the tunnel margins, reactive sclerosis, and the presence of bone within the tunnel were used as signs of adequate healing. 3. For a better experience, please enable JavaScript in your browser before proceeding. Your going to need to get very familiar with 2017 CMS NCCI Surgical Policy Manual. (C) Sagittal magnetic resonance imaging showing insufficiency of the anterior cruciate ligament graft. 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. A total 75 patients (75 knees) who underwent ACL reconstruction with tibialis anterior allografts were investigated between February 2015 and October . For example, patients may require bone grafting of prior graft tunnels, and then have the ACL revision in a second stage. Varus or valgus malalignment can put strain on an ACL graft, whatever the malalignment's cause the patient's physiology, failed meniscal surgery or cartilage problems. I would look at billing 29877 for the debridement of the soft tissue. Increasing expectations from arthroscopic anterior cruciate ligament (ACL) reconstructions require precise knowledge of technical details such as minimum intra-femoral tunnel graft lengths. These lesions are often difficult to see on MRI. Please enable it to take advantage of the complete set of features! Background: Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? You must log in or register to reply here. doi: 10.2106/JBJS.ST.20.00055. In 2 studies, the authors investigated the outcomes of allograft: allograft bone matrix (ABM) and allograft bone chips (AC). There are several techniques for bone grafting tunnels in one- or two-staged ACL revision procedures with either autograft or allograft. Her alignment, tibial slope and cartilage were all normal. MeSH The tibial tunnel looked to be in a good position. CPT codes are grouped into 6 sections: 1. 2023 BioMed Central Ltd unless otherwise stated. -Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. Noyes et al. He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. TECHNIQUE STEPS. Clinically, many authors have reported good results for two-staged revision ACLR using autograft bone [4, 11]. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. Part of 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. Enhancement of tendon-to-bone healing after anterior cruciate ligament reconstruction using bone marrow-derived mesenchymal stem cells genetically modified with bFGF/BMP2. Guide pins were placed in the tibial tunnel and next putty and dowels (grafts) were placed in the tibial and femoral tunnels. Privacy Finally, 1 study compared ICBG to a synthetic bone substitute. Purpose: To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. Unless the surgeon looks specifically for a ramp lesion at the time of ACL surgery, the lesion can be missed. 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. This provides a cylindrical graft, which is delivered to the femoral tunnel through the arthroscopic portal. Approximately 200,000 anterior cruciate ligament (ACL) ruptures occur in the United States annually. Arthrosc Tech. All rights reserved. [31] used Si-CaP for a bone-graft substitute for tunnel augmentation in two-stage revision ACLR. Arthroscopy 21:767, Wilson TC, Kantaras A, Atay A, Johnson DL (2004) Tunnel enlargement after anterior cruciate ligament surgery. Article | Outpatient Surgery Magazine - Association of periOperative 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. [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 . Bone graft substitute for tunnel filling improved ACL reconstruction 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]. CT scans to confirm healing at 3-5months after bone grafting [4, 12, 33, 34]. Reports suggest that a two-stage procedure is performed in only 8 to 9% of revision ACLRs [6]. - Discussion: 4. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. - Editorial: The Lateral Intercondylar RidgeA Key to Anatomic Anterior Cruciate Ligament Reconstruction Sometimes we can perform a biplanar osteotomy to correct both planes of deformity at once. Some authors have described the additional use of CT scans to confirm healing at 35months after bone grafting [4, 12, 33, 34]. doi: 10.1016/j.arthro.2006.07.054. Bethesda, MD 20894, Web Policies Aust N Z J Surg 69:517521, Eagan MJ, McAllister DR (2009) Biology of allograft incorporation. official website and that any information you provide is encrypted Two-stage revision anterior cruciate ligament reconstruction, https://doi.org/10.1186/s43019-019-0010-6, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Autograft was used in 4 studies: iliac crest bone autograft (ICBG, n = 3) and tibial bone autograft (TBA, n = 1). To read the full article, sign in and subscribe to the AHA Coding Clinic for HCPCS. - ref: Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. stream Bone Grafting Technique in Revision ACL Reconstruction: Coring Reamer and Dowel Trick. It may not display this or other websites correctly. You are using an out of date browser. 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. 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]. Levy, M.D., an orthopedic surgeon specializing in sports medicine at Mayo Clinic in Rochester, Minnesota, discusses Mayo's approach to revision ACL surgery. He is only grafting the bone. Am J Sports Med 40:800807, Article 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]. Please enable it to take advantage of the complete set of features! For an allograft, a single bone dowel approximately 1mm larger than the diameter of the tunnel is used and placed using a bone tamp for a press-fit technique, ensuring that the entire tunnel is filled [4]. Postoperatively, no complications were reported and none of the included patients had a flexion or extension deficit. Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery. 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. They recommended that two-stage reconstruction could be safely performed at 24weeks after bone grafting by the iliac-bone block-grafting technique. 29866 is for autografts (from the patient). 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 . 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. The slope causes the tibia to move forward and the femur to fall backward, putting tremendous strain on the ACL. 8600 Rockville Pike While one-stage revision ACLR is well described and reported, few studies have reported the outcomes of two-stage revision ACLR. 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). Thomas et al. There is no code for bone grafting. The second stage of the revision ACLR was performed a minimum of 3 months later, after obtaining a CT demonstrating adequate filling of the tunnels using a hamstring autograft though a transtibial drilling technique. No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. Modified Transtibial Versus Anteromedial Portal Technique in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction. Unfortunately, the most common cause for failure is related to technical issues from the primary ACL surgery, with malposition of the sockets and tunnels, particularly on the femoral side. sharing sensitive information, make sure youre on a federal Purpose: - one incision transtibialtechnique 2015;43:2510. doi: 10.1016/j.eats.2021.11.019. 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. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. At Mayo Clinic, we also are evaluating surgical techniques for ACL reconstruction, as well as optimal approaches to multiligament knee reconstruction. 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). 2018 Apr-Jun;9(2):116-120. doi: 10.1016/j.jcot.2018.02.010. The bone grafting is an opportune time to do an osteotomy to correct the malalignment. Epub 2018 Dec 17. MeSH Comparing Bone-Tendon Autograft With Bone-Tendon-Bone Autograft for ACL 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. Wheeless' Textbook of Orthopaedics. 2003 Jan;34(1):49-64. doi: 10.1016/s0030-5898(02)00070-6. 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. Physical therapy with muscle-strengthening and proprioceptive training can be performed. 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. My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable. What other specialized procedures might be performed in conjunction with ACL revision surgery? A clinical, prospective, randomized, double-blind study. With each added degree of inclination, one gains 0.68 mm of tibial tunnel length. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. - Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study They observed that an average of 5.8months was needed for healing of the autograft dowel to become visible on CT scans [11]. 2005 Nov;33(11):1701-9. doi: 10.1177/0363546505276759. There was also a significant improvement in the Lysholm score when comparing preoperative and postoperative values. Comparison of Femoral Tunnel Position and Clinical Results. Data Trace Publishing Company Kim, DH., Bae, KC., Kim, DW. The surgeon submitted CPT code 25431 alone. Surgery is often recommended to restore knee strength and function by reconstructing a damaged ACL with a graft. 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. J Bone Joint Surg Br 89:10511054, Article Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. Knee Surg Sports Traumatol Arthrosc 21:20722080, Magnussen RA, Debieux P, Benjamin B, Lustig S, Demey G, Servien E et al (2012) A CT-based classification of prior ACL femoral tunnel location for planning revision ACL surgery. National Library of Medicine Anterior cruciate ligament (ACL) reconstruction rates have increased over the past 20years to roughly 200,000 per year [1]. Previous literature has reported that if the tunnel size exceeds 1015mm, two-stage surgery should be performed. Unable to load your collection due to an error, Unable to load your delegates due to an error. femoral tunnel too far anterior in the notch; - graft that tightens (pulls up into the tibial tunnel) with flexion will have a much higher likelyhood offailure and usually indicates a Springer Nature. Root tears also put tremendous forces on the ACL graft and can lead to rotational instability and graft failure. FOIA - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. 2013;41:1296. et al. Revision ACL surgery: A comprehensive approach. - consider whether there is an interplay between posterior graft placement and appropriate graft tension; If this is your first visit, be sure to check out the. This site complies with the HONcode standard for trustworthy health information: verify here. Salem HS, Axibal DP, Wolcott ML, et al. Researchers randomly assigned 40 patients undergoing two-stage revision ACL reconstruction to receive either autologous iliac crest cancellous bone graft for tunnel grafting (control group; n=20) or silicate-substituted calcium phosphate in the form of sculptable microgranules (Actifuse MIS System, Baxter) as a bone graft substitute . Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up. Orthopaedic Specialists of North Carolina. 2017 Oct;475(10):2459-2468. doi: 10.1007/s11999-017-5278-9. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. 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 ACL injuries most commonly occur during sports that involve sudden stops and changes in direction such as soccer, football, basketball and volleyball. Additionally, Brown and Carson [20] regarded patients with a bone tunnel of <15mm diameter as good candidates for grafting. The indications for staged ACL reconstruction and the rehabilitation protocol between stages need to be clearly established. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. 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. endobj A Retrospective Comparative Study. 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. Sci Rep (2016) 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. For assessment of bone-graft incorporation, radiographs are routinely used. Example: 29888 - ACL Repair G0289 - Arthroscopy, knee, surgical, for removal of loose body, Harvesting and inserting the graft is included in code . <> Tibial tunnel cyst | Radiology Reference Article | Radiopaedia.org Knee-laxity measurements were elevated in the without-revision group, but the difference was not significant. Patrick C. McCulloch MD. 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. I am still awaiting the OP note from the ASC, which takes weeks, so I can't post it. eCollection 2021 Dec. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. - w/a right knee, place the tunnel at about the 9:30 to 10 oclock position; He did other procedures, but I have the codes for them. 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. 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]. Telephone: 410.494.4994, Morphology of the Femoral Intercondylar Notch, The Lateral Intercondylar RidgeA Key to Anatomic Anterior Cruciate Ligament Reconstruction. For a better experience, please enable JavaScript in your browser before proceeding. Our Experience: 2014 - 2018 . In active young patients, failed primary ACLR may require a revision ACLR. 8600 Rockville Pike Uchida et al. Not applicable, this is a review article. performed a CT scan at 4months to assess healing of the bone graft in the tibial tunnel. Purposes: We sought to introduce our new technique of Bashti bone plug for fixation of soft tissue graft in anterior cruciate ligament (ACL) reconstruction and to compare . Towson, MD 21204 endobj TECHNIQUE STEPS. 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.