(C) Sagittal magnetic resonance imaging showing insufficiency of the anterior cruciate ligament 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. The femoral tunnel was easily visualized with flexing the knee beyond 90 degrees. Overview. 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? TJ!!X`Sz9Q*BeV={=F ' 0y^*2| '! All the patients in the study underwent screw removal and filling of the tunnels with an autograft harvested from the anterior tibial metaphysis. -notchplasty 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. No charge. 1998-2023 Mayo Foundation for Medical Education and Research. 2003 Jan;34(1):49-64. doi: 10.1016/s0030-5898(02)00070-6. 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. - open technique(which might be required with arthroscopy malfunction). Unauthorized use of these marks is strictly prohibited. 2. eCollection 2022 Jun. doi: 10.1016/j.eats.2022.01.004. and transmitted securely. . Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. - 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; 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 insertion of an interference screw not only compresses the graft in the tunnel but also leads to an enlargement of the bone tunnel itself [13]. 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. % I just want to get the basic idea so I can advise him since he keeps a copy of his billing. 2020;38:1191. The femoral tunnel was a little high. Two-stage revision 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. JavaScript is disabled. At Mayo Clinic, we frequently perform osteotomies to correct both sagittal plane and coronal plane deformity. Ramp tears can lead to rotational instability and put excessive strain on the ACL graft, causing it to fail. A Meta-analysis of 47,613 Patients. Thomas et al. Excessive tibial slope also puts patients at much higher risk of early ACL reconstruction failure. Spine J 7:475490, Jenis LG, Banco RJ (2010) Efficacy of silicate-substituted calcium phosphate ceramic in posterolateral instrumented lumbar fusion. For example, patients may require bone grafting of prior graft tunnels, and then have the ACL revision in a second stage. An Observational Study Using Navigated Measurements 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. - tunnel positioning: Epub 2005 Aug 10. A revision procedure may be performed to improved knee function, correct instability, and facilitate a return to normal activities. registered for member area and forum access. Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. 2020 Sep;140(9):1211-1219. doi: 10.1007/s00402-020-03421-7. Cancellous allogenic and autologous bone grafting ensure comparable tunnel filling results in two-staged revision ACL surgery. Privacy Federal government websites often end in .gov or .mil. I am still awaiting the OP note from the ASC, which takes weeks, so I can't post it. - over the top repair tensioned in extension will provide support in terminal extension but may slacken at greater flexion angles; Bone and Joint Clinic. Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel. Get timely coding industry updates, webinar notices, product discounts and special offers. A new harvest site for bone graft in anterior cruciate ligament revision surgery. Learn how to get the most out of your subscription. 8600 Rockville Pike This adds a fair amount of complexity to the procedure. Neil Duplantier MD. The authors declare that they have no competing interests. doi: 10.2106/JBJS.ST.20.00055. Bone Graft related CPT Codes. Background: Ligament reconstruction is a common procedure in orthopedic surgery. 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. Cancel anytime. Unfortunately, both previous reconstructions were performed with allograft (cadaver) tissue, which has been shown to have significantly higher failure rates in young patients compared with autograft (the patient's own tissue). At a mean follow-up of 7.9years, clinical scores following revision ACLR did not differ significantly according to the tunnel size. Stage II lateral root tear, lateral root repair and repeat revision back-to-back ACL repair. [38] have reported the outcomes of revision ACLR with and without lateral extra-articular tenodesis. Battaglia and Miller [12] indicated that bone grafting should be performed in cases with a tunnel diameter of 1015mm. It may not display this or other websites correctly. This content does not have an Arabic version. Hello, our physician bone grafted the previous ACL tunnels with allograft via arthroscopy. Remaining soft tissue was debrided along tibia. 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. statement and femoral tunnel too far anterior in the notch; 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. We routinely obtain hip-to-ankle AP X-rays to assess for any coronal plane malalignment. Patrick C. McCulloch MD. Our Experience: 2014 - 2018 . 7 0 obj In the immediate postoperative period, the weakest part of any ACLR is the fixation. Postoperatively, no complications were reported and none of the included patients had a flexion or extension deficit. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. The patient also had an unrecognized complete disruption of her lateral meniscal root and excessively widened tunnels and sockets. 2002 Richard O'Connor Award paper. The AHA Coding Clinic for HCPCS includes: Thank you for choosing Find-A-Code, please Sign In to remove ads. MARS Group. - A Comparison of 2 Drilling Techniques on the Femoral Tunnel for Anterior Cruciate Ligament Reconstruction The .gov means its official. - Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation Drilling the Femoral Tunnel During ACL Reconstruction: Transtibial Versus Anteromedial Portal Techniques. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Conclusions. An average Lysholm score at 2 years post operation was 96.6 points 2.1 (91100 points). 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. Preoperative planning is critical to identify and characterize bone tunnel pathology. Salem HS, Axibal DP, Wolcott ML, et al. 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. 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 . 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. 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. Springer Nature. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. TECHNIQUE STEPS. He did other procedures, but I have the codes for them. Then in that case, yes, I would code this as 29888-52. Abstract The . Patients who underwent ACL reconstruction (Current Procedural Terminology (CPT) code 29888) between 20 were identified using the PearlDiver database. Arthrosc Tech. The new ligament was fixed to the tibia by a metallic screw and to the femur by a bioabsorbable screw. [43] reported the results of 54 patients who underwent bone grafting due to recurrent, symptomatic ACL deficiency following ACLR. A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. 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. 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. Accessibility 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 restricts flexion of knee if graft remains intact, or it may elongate graft if the range of motion is restored; Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. - surgeon will also note more perpendicular drill angle to bone surface with AM vs TransTibial drilling; To minimize the risk of viral and bacterial contamination, allograft bone is sterilized. - lateral tunnel placement: Her alignment, tibial slope and cartilage were all normal. What code(s) would be reported for the open removal of retained deep hardware, along with placement of bone graft to the femur and tibial tunnels? The prior skin incision is typically used to expose the distal portion of the tibial tunnel. This study aims to identify potential factors for both femoral and tibial tunnel widening (TW) and to investigate the effect of TW on postoperative outcomes after anterior cruciate ligament (ACL) reconstruction with a tibialis anterior allograft. Clipboard, Search History, and several other advanced features are temporarily unavailable. Uchida et al. Uchida et al. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. 2023 BioMed Central Ltd unless otherwise stated. 2007 May;23(5):558.e1-4. Disclaimer. Approximately 200,000 anterior cruciate ligament (ACL) ruptures occur in the United States annually. Cite this article. However, methods used to sterilize allograft material (e.g., gamma irradiation and autoclaving), are known to adversely affect the structural and other properties of the graft material [25]. Knee-laxity measurements were elevated in the without-revision group, but the difference was not significant. - over the top position: 8 Therefore, one should avoid angles <40 to 45 . It may not display this or other websites correctly. 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. Thomas et al. Arthrosc Tech. TECHNIQUE VIDEO. 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. 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]. In addition, patients who receive revision ACL surgery might have other damaged ligaments. Epub 2020 Apr 1. 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. Results: a statistical evaluation. 2015;43:2510. An official website of the United States government. - Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Christensen JJ, et al. Federal government websites often end in .gov or .mil. Please enable it to take advantage of the complete set of features! stream ACL injuries most commonly occur during sports that involve sudden stops and changes in direction such as soccer, football, basketball and volleyball. Two years after the surgery, she resumed all activities and plays collegiate volleyball. Patients were divided into the isolated revision ACLR group (n=45) and the revision ACLR group in combination with ALL reconstruction (n=42). To date, the literature on revision ACLR surgery has primarily focused on comparing the outcomes to those of primary ACLR. doi: 10.1016/j.eats.2021.08.013. Knee Surgery & Related Research 2021 Oct 12;11(4):e20.00055. - Discussion: The site is secure. 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. Grassi A, Nitri M, Moulton SG, Marcheggiani Muccioli GM, Bondi A, Romagnoli M, Zaffagnini S. Bone Joint J. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. It is technically difficult to deliver and impact bone graft into the femoral tunnel with the standard surgical and arthroscopic instruments. TECHNIQUE STEPS. However, Thomas et al. 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. 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 . It does not hit an edit, but be prepared for insurance to deny it. Epub 2018 Feb 23. proprioceptive reflex leading to a functional extension loss while the patient is awake. If this is your first visit, be sure to check out the. - references: We NEVER sell or give your information to anyone. American Journal of Sports Medicine. 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. It is commonly injured during high-intensity sports. Knee Surg Sports Traumatol Arthrosc 20:12981306, Brown CH Jr, Carson EW (1999) Revision anterior cruciate ligament surgery. Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up. Please enable it to take advantage of the complete set of features! - this represents the closest reconstitution of the ACL's "physiometry"; (see: isometry); <> Drilling a tibial tunnel at 40 degrees yields an average tunnel length of 45.442.18 mm. 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. JavaScript is disabled. [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. <> - Reflex extension loss afteranterior cruciate ligamentreconstruction due to femoral "high noon" graft placement. 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. Make a donation. - resulting anterior-posterior cruciate ligament impingement near extension caused a persistentfunctional extension deficit of 20; Stage I femoral and tibial bone grafting. A clinical, prospective, randomized, double-blind study. -Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction. Griffith TB, et al. 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). Arthroscopy 33:819827, Diamantopoulos AP, Lorbach O, Paessler HH (2008) Anterior cruciate ligament revision reconstruction: results in 107 patients. Achieving the correct position can be tricky. Some authors have described the additional use of CT scans to confirm healing at 35months after bone grafting [4, 12, 33, 34]. The .gov means its official. A single copy of these materials may be reprinted for noncommercial personal use only. - Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study Diermeier et al. 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. 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]. They recommended that two-stage reconstruction could be safely performed at 24weeks after bone grafting by the iliac-bone block-grafting technique. They observed that an average Bone Grafting Tibial and Femoral Tunnels knee Portion of op note reads as follows: ACL was completely absent in mid aspect. 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. A Retrospective Comparative Study. %PDF-1.5 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. [21] evaluated 88 patients who underwent one-stage revision ACLR. Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. Am J Sports Med. 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]. 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. The bone graft is deployed, and plunger can be used to gently pack graft into tunnel. 2 0 obj -Morphology of the Femoral Intercondylar Notch - ref: Correlation between femoral tunnel length and tunnel position in ACL reconstruction. However, remarkable advances in knowledge of this process have been made based primarly on animal models. Correlation between femoral tunnel length and tunnel position in ACL reconstruction. Thomas et al. registered for member area and forum access. Femoral and Tibial Tunnel Bone Grafting for Stage 1 Revision ACL Reconstruction 10,878 views Apr 25, 2017 NewYorkOrtho 25K subscribers Notice. PubMedGoogle Scholar. performed a CT scan at 4months to assess healing of the bone graft in the tibial tunnel. 1 0 obj - graft that tightens (pulls up into the tibial tunnel) with flexion will have a much higher likelyhood offailure and usually indicates a Example: 29888 - ACL Repair G0289 - Arthroscopy, knee, surgical, for removal of loose body, Harvesting and inserting the graft is included in code . Bruce A. We thank Eun-Ji Jeon and Min-Ji Kim for their support. Outcomes of repeat revision anterior cruciate ligament reconstruction. Manage cookies/Do not sell my data we use in the preference centre. If any of those ligaments were missed in the initial knee surgery, they can be treated in the revision setting. 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 Tunnel malpositioning and widening remain the most common indications for two-stage revision ACLR. Jul 22, 2009. Clifford R. Wheeless, III, M.D. 110 West Rd., Suite 227 Bethesda, MD 20894, Web Policies Background: Few studies report the outcomes of two-stage revision ACLR alone. 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. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. 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. Epub 2018 Dec 17. 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]. 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. Revision ACLR surgeries can be mainly divided into one-stage and two-stage procedures. 2017 Jun;99-B(6):714-723. doi: 10.1302/0301-620X.99B6.BJJ-2016-0929.R2. endobj Mosaicplasty. If this is your first visit, be sure to check out the. I am still awaiting the OP note from the ASC, which takes weeks, so I can't post it. Title: Slide 1 Author: Charles H Brown Created Date: 12/3/2018 11:52:05 AM . The tibial tunnel looked to be in a good position. Hi you mentioned this was a staged procedure - any chance you can post the entire operative report without patient info? registered for member area and forum access. Epub 2016 Dec 30. - historic techniques: 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]. <> official website and that any information you provide is encrypted FOIA [34] reported 10 consecutive patients (four female and six male patients with a mean age of 28years) who underwent autogenous bone grafting prior to ACLR revision. endobj While one-stage revision ACLR is well described and reported, few studies have reported the outcomes of two-stage revision ACLR. They are benign ganglion cysts that develop in or around the osseous tibial tunnel made during ACL reconstruction using the transtibial technique 1-2. a meta-analysis of 32 studies. However, with precise indications, proper preoperative planning and operative-technique selection, two-stage revision ACLR can achieve favorable outcomes. 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. Previous literature has reported that if the tunnel size exceeds 1015mm, two-stage surgery should be performed. 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]. Study design: Systematic review. Lateral tibial posterior slope is increased in patients with early graft failure after anterior cruciate ligament reconstruction. You must log in or register to reply here. Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. 2005 Nov;33(11):1701-9. doi: 10.1177/0363546505276759. Journal of Orthopaedic Research. Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction? 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]. Conclusion: PMC Epub 2018 Dec 17. 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. Does the type of graft affect the outcome of revision anterior cruciate ligament reconstruction? 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. To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. Am J Sports Med 40:800807, Article American Journal of Sports Medicine. Anterior cruciate ligament (ACL) reconstruction remains the gold-standard treatment for young active patients with functional instability after an ACL injury.