Preventing Blood Clots After Orthopaedic Surgery, Preventing Infection After Joint Replacement Surgery. Although recovery after revision surgery is usually slower than recovery after primary total knee replacement, the type of care you will receive is very similar. Your surgeon will use a piece of tendon from another part of your knee or a tendon from a deceased donor. The .gov means its official. Keywords: Thermal Shrinkage Thermal ACL shrinkage is a surgical anomaly when compared to other ACL procedures because it is minimally invasive and generally much faster than a traditional or arthroscopic ACL repair. Infection has to be ruled out prior to planning any reconstructive surgical procedure. Epub 2011 Jun 6. Revision ACL reconstruction can be performed in one or two stages. National Library of Medicine (Top): Examples of metal augments that can be added to implants to make up for lost bone. 0000008438 00000 n Special complexities associated with a revision include the following: Coders reporting ACL revisions encounter the same limitations as they do for reconstructions essentially one code to describe any arthroscopic ACL procedure. 0000018637 00000 n CT examinations were performed at three, 12 and 24weeks after bone grafting. The possible risks and complications of revision surgery include: Managing Pain With Medications After Orthopaedic Surgery. Right knee arthroscopy, viewing from the anterolateral portal, knee is 30 flexion and valgus force applied. The anatomic tunnel position shown with blue arrow, Authors decision-making algorithm for a patient with a failed ACLR (, Bonepatella tendonbone graft with a tongue of bone on the tibial side which can be used to fill up defect in the tunnel during a one-stage revision ACL reconstruction. It may also feel stiff or unstable, making it difficult to perform your everyday activities. 0000006441 00000 n In a click, check the DRG's IPPS allowable, length of stay, and more. 2019 Sep 18;31(1):10. doi: 10.1186/s43019-019-0010-6. eCollection 2020 Dec. Knee Surg Relat Res. 2011 Sep;39(9):1889-93. doi: 10.1177/0363546511406871. 8600 Rockville Pike 0000076190 00000 n Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. 0000076786 00000 n and estimate how much more difficult (e.g. [BTB allograft for revision surgery of the anterior cruciate ligament - part 2]. trailer When the bone is shattered or weakened from osteoporosis, the damaged section of bone may need to be completely replaced with a larger revision component. Search across Medicare Manuals, Transmittals, and more. xref Severe tunnel dilatation, infection, or arthrofibrosis necessitates a two 0000006046 00000 n Unauthorized use of these marks is strictly prohibited. The incidence of anterior cruciate ligament (ACL) tears in the United States is over 250,000, 1 of which around 65% proceeds to ACL reconstruction (ACLR). Regardless of whether the physician has to graft tendon and remove the ACL stump or simply anchor the stretched ACL to the patella without need for grafting or removal of damaged tendon the code is the same. Unauthorized use of these marks is strictly prohibited. The anesthesia team, with your input, will determine which type of anesthesia will be best for you. In a 2-stage surgery, the implant is removed, the joint is washed out, and a temporary cement spacer is placed in your knee. 0000005807 00000 n Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. This percentage will help the payer to determine what extra percentage of the normal fee to reimburse for the extra work. Was the "AL" meant to be "ACL" or "ALL". Please note that: Procedure Codes Schedule 0000021963 00000 n Arthroscopic or open ACL repair, thermal ACL shrinkage, revisions, and ACL repair along with other knee procedures make for coding headaches and reduced reimbursements, but you can avoid both through thorough documentation and correct modifier use. In many areas, nonessential orthopaedic procedures that were postponed due to COVID-19 have resumed. Before Beighton Score, Tibial Slope, Tibial Subluxation, Quadriceps Circumference Difference, and Family History Are Risk Factors for Anterior Cruciate Ligament Graft Failure: A Retrospective Comparison of Primary and Revision Anterior Cruciate Ligament Reconstructions. 0000002938 00000 n ACL Reconstruction For practical purposes, in this day and time, all ACL Reconstructions are done Arthroscopically (or Arthroscopically Assisted). So only one unit could be billed even though mu Pt has knee dislocation diagnosis and physician bills 27427, 27428 for AL, PCL and MCL tear reconstruction. See this image and copyright information in PMC. Severe tunnel dilatation, infection, or arthrofibrosis necessitates a two-stage approach. Watch: Preventing Infection After Joint Replacement Surgery. 2021 Jan;37(1):195-205. doi: 10.1016/j.arthro.2020.08.031. He or she may also aspirate your knee. Two small portions of hamstring tendon are harvested (autograft) to create the new ACL. A portion of the patellar tendon is harvested (autograft) to create the new ACL. PDF | Revision anterior cruciate ligament (ACL) reconstruction is substantially more challenging than primary reconstruction. 0000004907 00000 n ACL Revisions ACL revision surgeries occur when an initial repair or reconstruction fails or the patient reinjures his or her ACL. WebThis case required a two-stage approach: Stage 1 consisted of bone grafting, followed by second-stage repeat revision ACL reconstruction with patellar tendon autograft, lateral Webdecides between a single-stage or a two-stage revision. If this occurs, metal augments and platform blocks can be added to the main components to make up for the bony deficits. After surgery, you will feel some pain. The site is secure. ACL problems are typically the result of pivoting, twisting, hyperflexion and hyperextension injuries to the knee. Correct me if I am mistaken. The spectrum of ACL failure includes symptoms of recurrent instability, pain, and/or stiffness. Intraarticular ligaments are the ligaments located inside the knee joint. Talk to your doctor if your pain has not begun to improve within a few days of your surgery. Special complexities associated with a revision include the following: the need to remove the old graft material screws and suture anchors possible need to revise the femoral and/or tibial tunnels (the drill holes made during the first ACL surgery) possible need to harvest graft from a distant site sometimes even the opposite knee presence of scar tissue complicating the surgical dissection. 2016 May 1;39(3):e456-64. My predecessor coded [], Copyright 2023. In most cases, he or she will use specialized implants with longer, thicker stems that fit deeper inside the bone for extra support. 2017 Feb 15;66:543-556. Epub 2016 Apr 5. In complex cases, the surgery may take several hours. 0000030828 00000 n Detailed patient assessment, imaging, and studying details of the index surgery are critical prior to planning revision surgery. Web1. 0000014533 00000 n Erickson BJ, Cvetanovich G, Waliullah K, Khair M, Smith P, Bach B Jr, Sherman S. Orthopedics. Removing the implant leads to a higher chance of curing the infection, but is associated with a longer recovery. (The patellar component is not shown here.). The femur (thighbone) has broken in several places around the implant. ACL surgery is defined by CPT 29888 (Arthroscopically aided anterior cruciate ligament He or she may recommend that you continue taking the blood-thinning and antibiotic medications that you started in the hospital. Level of evidence: presence of scar tissue complicating the surgical dissection. To determine whether you have an infection, your doctor may order blood tests. Bone Incorporation of Silicate-Substituted Calcium Phosphate in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic and Radiographic Study. Multiple revision anterior cruciate ligament reconstruction: not the best but still good. Arthroscopic or open ACL repair, thermal ACL shrinkage, revisions, and ACL repair along with other knee procedures make for coding headaches and reduced reimbursements, but you can avoid both through thorough documentation and correct modifier use. 0000007002 00000 n Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion-Based Rehabilitation Progression. All rights reserved. Epub 2016 Dec 30. When the tendon is harvested from the patient, harvesting takes place at the same time as the reconstructive surgery. Two-Stage Revision Anterior Cruciate Ligament Reconstruction. Discussion: minor synovial resection for visualization (e.g., 29875), articular shaving, debridement, chondroplasty (e.g., 29877, 29879), notchplasty (debridement of the intercondylar notch of the femur), ACL stump removal (replacement of ligament), synovectomy and fat-pad resection (e.g., 29875, 29876), intra-articular ligament reconstruction (e.g., 27428, 27558), the need to remove the old graft material screws and suture anchors, possible need to revise the femoral and/or tibial tunnels (the drill holes made during the first ACL surgery), possible need to harvest graft from a distant site sometimes even the opposite knee. A periprosthetic fracture is a broken bone that occurs around the components of a total knee replacement. Practices do not receive any less reimbursement when they bill 29888 for a repair but they similarly do not receive additional reimbursement when they bill 29888 for a reconstruction. 2. The incidence of anterior cruciate ligament reconstruction (ACLR) surgeries is increasing and so is the number of revision surgeries for a failed ACLR. trigger finger), Trigger point injection/Enthesis - 1 injection, Major release of muscle for pain or contracture (e.g. 0000103578 00000 n I think 27558 more appropriate. 2020 Dec 21;9(12):e1917-e1925. The https:// ensures that you are connecting to the WebIf they are larger than 12 to 14 mm in diameter, or are in a position where an anatomic positioning of the ACL reconstruction graft would break into the previously malpositioned tunnel, then a two-staged surgery would be recommended. eCollection 2022 Oct. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. And arthro-scopic ACL repair or reconstruction has only one code: 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction). Accessibility official website and that any information you provide is encrypted 0000006521 00000 n 0000003281 00000 n Sometimes, however, the knee remains stiff. It is important to continue moving and exercising your knee when you are home. Thermal ACL shrinkage is a surgical anomaly when compared to other ACL procedures because it is minimally invasive and generally much faster than a traditional or arthroscopic ACL repair. government site. Coding for arthroscopic reconstruction of anterior cruciate ligament (ACL) surgery. International Perspective on Revision Anterior Cruciate Ligament Reconstruction: What Have We Been Missing? The majority of patients who have revision surgery experience favorable long-term outcomes, including relief from pain and increased stability and function. 0000032820 00000 n It is rare to do them "Open." Arthroscopy. Price: $7,931 CPT Code: 29888 Anterior cruciate ligament reconstruction ( ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate 0000009928 00000 n Minor ACL injuries can be treated nonoperative-ly with physical therapy and bracing, and incomplete tears can be repaired without the use of graft material, whereas torn ACLs have to be reconstructed with the use of autograft or allograft tissue. Because most implants are designed to work with the patient's existing ligaments, any changes in those ligaments may prevent an implant from working properly. If the ligaments around your knee become damaged or improperly balanced, your knee may become unstable. 0000017565 00000 n Follow your doctor's instructions carefully to reduce your risk of developing complications, including blood clots and infection, during the first several weeks of your recovery. The ACL is located in the center of the knee, behind the kneecap, and runs from the femur to the tibia. The incision may be longer than the original, however, to allow the old components to be removed. Before your surgery, arrange for a friend, family member or caregiver to provide help at home. The surgeon should explain the specific complications he or she encountered (removal of graft material distant graft site etc.) 0000102737 00000 n Before With arthroscopic guidance, a thermal probe is inserted into the knee, where it heats the damaged ligament to shrink and tighten it. Medications are often prescribed for short-term pain relief after surgery. doi: 10.2106/JBJS.ST.20.00055. Infection is a potential complication in any surgical procedure, including total knee replacement. 2023. 0000003452 00000 n 8600 Rockville Pike 0000068971 00000 n 0000020410 00000 n Expected immediate post-operative ACL tunnel diameter should be around 10 mm regardless of graft selection. Revision ACL reconstruction maybe performed as a one-stage or two-stage procedure. sharing sensitive information, make sure youre on a federal Double-bundle non-anatomic ACL revision reconstruction with allograft resulted in a low revision rate at 10years. Complete pain relief and restoration of function is not always achievable, however, and some patients may still experience pain or knee stiffness following revision surgery. You may need a walker, cane, or crutches for the first few days or weeks until you are comfortable enough to walk without assistance. However modifier -22 should be used only if written documentation including an operative report intraopera-tive photos and a letter from the surgeon verify that the extra work was done. Etiological factors responsible for failure, Etiological factors responsible for failure of an anterior cruciate ligament failure ( RTS, Right knee arthroscopy, viewing from the anterolateral portal, knee in 90 flexion. This information is provided as an educational service and is not intended to serve as medical advice. 2021 Jan 29;9(1):2325967120977834. doi: 10.1177/2325967120977834. Accessibility Because the procedure is longer and more complex than primary total knee replacement, it has a greater risk of complications. 2023 Feb;31(2):559-571. doi: 10.1007/s00167-022-07197-8. Trends in Primary Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Practice in Adult Patients Prevalent Among Arthroscopy Surgeons of Six Southern States of India. Limited Coding Options Several codes describe open ACL repair and reconstruction, but with the advent and domination of arthroscopy, the codes are largely obsolete. The stretched ligament shrinks to its normal size, thus returning stability to the knee. 0000103082 00000 n Because your mobility will be limited after surgery, you may need help for several weeks with tasks like cooking, shopping, bathing, and doing laundry if you live alone. Instr Course Lect. Introduction: The indications for two-stage surgery were as follows: (1) the enlargement of Total knee replacement is one of the most successful procedures in all of medicine. Imaging tests. During the initial surgery, the implant was either cemented into the bone or press-fit to allow bone to grow onto the surface of the implant. The indications for two-stage surgery were as follows: (1) the enlargement of the tibial tunnel aperture was >20mm in diameter or, (2) the existing tunnel was overlapped with the optimal tunnel and positioned more than a half tunnel diameter posterior to the optimal position. Where do I start with choosing the right ACL graft for me?So which ACL graft type should a person choose if they elect to undergo ACL reconstruction surgery?Firstly, it is important to note that one of the first things to consider is the decision on whether or not to have ACL surgery in the first place.ACL reconstruction surgery is an elective procedure.More items A suture beneath your skin will not require removal. JOSPT 2012 Methods: Ten consecutive patients underwent autogenous bone grafting prior to ACL reconstruction revision (four females and six males, average age 28years). 0000103928 00000 n Diagnostic Tests Schedule An emerging procedure, thermal ACL shrinkage, is used to stretch injuries of the ligament that do not require tendon graft. And arthro-scopic ACL repair or reconstruction has only one code: 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction). eCollection 2022 Oct. Macchiarola L, Pizza N, Patania V, Grassi A, Dal Fabbro G, Marcacci M, Zaffagnini S. Knee Surg Sports Traumatol Arthrosc. 0000017278 00000 n American Hospital Association ("AHA"). 0000006842 00000 n MeSH 0000020057 00000 n Two-stage revision anterior cruciate ligament reconstruction. Your doctor will examine the soft tissues in your knee to make sure that they are free from infection. Would you like email updates of new search results? 0000034378 00000 n 0 Arthroscopic ACL reconstruction is a much more involved procedure than arthroscopic ACL repair" " says Susan Callaway CPC CCS-P an independent coding consultant and educator based in North Augusta S.C "yet there is just one code to describe the procedure." With two exceptions HCPCS code G0289 (Surgical knee arthroscopy for removal of loose body, foreign body, debridement/shaving of articular cartilage at the time 5. 305 102 The implant may begin to lose its attachment to the bone. Advances in material science and plastic quality have made osteolysis less common today than in past decades. 0000002336 00000 n CPT GUIDELINES indcates that when the physician cannot complete the procedure through the arthroscope, and an open procedure is performed, list the open procedure first, code the scope diagnostic, and append modifier 51. He or she will assess all the metal and/or plastic parts of the prosthesis to determine which parts have become worn or loose or shifted out of position. 2022 Sep 17;11(10):e1667-e1674. 0000020113 00000 n Depending on your condition, you may need to stay at a nursing facility or rehabilitation center for some time after you leave the hospital. Ten consecutive patients underwent autogenous bone grafting prior to ACL reconstruction revision (four females and six males, average age 28years). Two small portions of hamstring tendon are harvested (autograft) to create the new ACL. and transmitted securely. Would you like email updates of new search results? A two-stage I'm not sure what code was meant to be billed with 27427 for the Lemaire. official website and that any information you provide is encrypted Reproduced from Parvizi J, Azzam K: Periprosthetic fractures about the knee, American Academy of Orthopaedic Surgeons website: Orthopaedic Knowledge Online Journal, 2008. When the tendon is harvested from the patient, harvesting takes place at the same time as the reconstructive surgery. Conclusion: Keywords: Osseous malalignment in the coronal or sagittal planes would also need correction along with or prior to revision ACL surgery. According to the American Academy of Orthopaedic Surgeons' (AAOS) Complete Global Service Data Guide, 29888 includes the following procedures: The scarcity of codes for the ACL repair reveals the reimbursement challenge. The Codes 24707 (repair) and 27427, 8, & 9 (reconstruction/augmentation, intra or extra-articular) are for open procedures. Tunnel Enlargement Correlates With Postoperative Posterior Laxity After Double-Bundle Posterior Cruciate Ligament Reconstruction. Rarely, bone graft material may be used to help rebuild the knee. To prevent infection, you will be given antibiotics before and, in some cases, after surgery. Repair of the ACL involves using sutures to anchor the torn ligament to its original point of attachment on the femur to set it back into its correct anatomic site. Conflict of interestSachin Tapasvi and Anshu Shekhar declare that they have no conflict of interest. 0000019179 00000 n There are three main sources of autograft: bone-tendon-bone (BTB) graft of the patellar tendon or a tendon graft from hamstring or quadricep tendon. Two-stage revisions are rarely performed, but are particularly useful when addressing substantial tunnel-widening, active 0000004444 00000 n The site is secure. Autografts are preferred for revision ACL due their lesser re-tear rates and better outcomes. Federal government websites often end in .gov or .mil. You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. PMC %%EOF 0000018696 00000 n This is a natural part of the healing process. Your physical therapist will provide you with specific exercises to increase your strength and mobility and improve your ability to do everyday activities. This may happen if excessive scar tissue has built up around the knee joint. Watch: Preventing Blood Clots After Orthopaedic Surgery. (Left) In this tibial component, an additional block has been attached to make up for lost bone. Once the incision is made, the doctor will move the kneecap and tendons to the side to reveal your knee joint. In osteolysis, the bone around the implant deteriorates, making the implant loose or unstable. In this procedure, joint fluid is removed using a needle and syringe, then analyzed in a laboratory to determine if infection is present. The average BMD was 510 and 571mg/cm(3) at 12 and 24weeks, respectively, with a significantly higher value at 24weeks. Aim: 0000009431 00000 n American Hospital Association ("AHA"), Posterolateral Corner Reconstruction Knee. Unfortunately, it's not always that straight forward. (Right) In revision surgery, components with longer stems fit more securely into the bones and provide stability. PMC Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, 237-241. If your knee replacement fails, your doctor may recommend that you have a second surgeryrevision total knee replacement. 0000007234 00000 n FOIA Hello everyone! If knee instability cannot be treated through nonsurgical means such as bracing and physical therapy, revision surgery may be needed. 0000013979 00000 n Find out more here. The surgeon uses the middle third of the patient's quadriceps tendon and a bone plug from the upper end of the kneecap, which produces a larger graft for taller and heavier patients. Minor ACL injuries can be treated nonoperative-ly with physical therapy and bracing, and incomplete tears can be repaired without the use of graft material, whereas torn ACLs have to be reconstructed with the use of autograft or allograft tissue. The cause of loosening is not always clear, but high-impact activities, excessive body weight, and wear of the plastic spacer between the two metal components of the implant are all factors that may contribute. sharing sensitive information, make sure youre on a federal 0000006284 00000 n Outcomes of Combined Lateral Meniscus Posterior Root Repair and Anterior Cruciate Ligament Reconstruction. Both can't be billed. These may include special graded compression stockings, inflatable leg coverings (compression boots), and blood thinners. 0000004329 00000 n This has led this group of authors to suggest 4 we should wait till 2-years post ACL surgery for return to sport! I suspect that two years may be overly conservative for most people, while 6-months will be too soon for the majority; in reality, recovery time will be dependent upon the individual and their progress. Knee Surg Sports Traumatol Arthrosc. Even if the implant remains properly fixed to the bone, pain, swelling, and drainage from the infection usually make revision surgery necessary. Osti L, Buda M, Osti R, Massari L, Maffulli N. Sports Med Arthrosc Rev. 0000010106 00000 n When revisions include complexities like those listed above the coding option is to append modifier -22 (Unusual procedural services) to 29888. 20 percent 30 percent) the procedure was as a result of this altered surgical field. If you are admitted to the hospital, you may stay for several days. 27427 is ligamnet reconstruction extra articular = iliot CPT GUIDELINES indcates that when the physician cannot complete the procedure through the arthroscope, and an open procedure is performed, list the open procedure first, code the scope diagnostic, and Read a CPT Assistant article by subscribing to. NCI CPTC Antibody Characterization Program. Knee Surg Relat Res. If this occurs, your doctor may attempt "manipulation under anesthesia.". Before surgery, you will be evaluated by a member of the anesthesia team. 2 The recommended management for ACL tears in young active patients with functional instability following an ACL tear is ACLR. 0000005244 00000 n Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. Acta Chir Orthop Traumatol Cech. Malpositioned, Authors decision-making algorithm for a, Authors decision-making algorithm for a patient with a failed ACLR ( CBC complete, Bonepatella tendonbone graft with a tongue of bone on the tibial side which, Right knee arthroscopy, viewing from the anterolateral portal, knee is 30 flexion and, MeSH 0000004102 00000 n 2017 Mar;25(1):19-29. doi: 10.1097/JSA.0000000000000140. Epub 2018 Dec 17. Over time, however, an implant may loosen from the underlying bone, causing the knee to become painful. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. As the major stabilizing ligament of the knee, it prevents buckling and instability. These fractures are most often the result of a fall, and usually require revision surgery. 0000004790 00000 n View matching HCPCS Level II codes and their definitions. After removing the original implant, your doctor will prepare the bone surfaces for the revision implant. Extra-articular reconstruction for controlling anterolateral instability is frequently required as well. Malpositioned femoral tunnel (shown with chondral pick) above the intercondylar ridge (dotted line) seen during revision surgery. Because of the already surgically altered operative field ACL revisions are more complex than repairs or reconstructions. Disclaimer. HHS Vulnerability Disclosure, Help Not only must the new graft become a part of your knee, a process called graft incorporation, but you need to restore normal muscle strength to ensure the knee is well protected. Disclaimer. All material on this website is protected by copyright. (Right) An x-ray of the augmented component in place within the knee. Coders reporting ACL revisions encounter the same limitations as they do for reconstructions essentially one code to describe any arthroscopic ACL procedure. You will either be admitted to the hospital on the day of surgery or you will go home the same day. As the major stabilizing ligament of the knee, it prevents buckling and instability. This percentage will help the payer to determine what extra percentage of the normal fee to reimburse for the extra work. Over time, however, a knee replacement may fail for a variety of reasons. " There are several methods by which a physician can achieve anterior cruciate ligament (ACL) revision or reconstruction, but only two codes to describe them. The Danish registry recently published a report indicating that 3% of all ACL reconstructions were revised within the first 2 years. Tunnel widening is generally cavitary, frequently maximal The https:// ensures that you are connecting to the Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster. This is then followed by intravenous antibiotics. You may need some help at home for several days to several weeks after discharge. ACL revision surgeries occur when an initial repair or reconstruction fails or the patient reinjures his or her ACL. 0000005136 00000 n Conclusion: In the case of allografts, a low level of immunologic reaction can weaken the graft and cause early failure as well. Welder E, Magnussen RA, Fitzpatrick S, Duerr RA, Kaeding CC, Flanigan DC. Doing so indicates to the payer that extra work was performed above and beyond the normal scope of the procedure. 0000008780 00000 n Because the amount of work with a thermal shrinkage is far less than that involved with arthroscopic ACL repair (there are no sutures and only one incision for the scope) experts agree that the unlisted arthroscopy code (29999 Unlisted procedure arthroscopy) is appropriate to submit for this claim. Preoperative Planning for ACL Revision Surgery. 0000003987 00000 n If cement was used in the primary total knee replacement, this is removed, as well. 2016 May 1;39(3):e456-64. Does anyone know which ligaments are intra-articular & which are extra-articular? 2023 Jan;31(1):340-348. doi: 10.1007/s00167-022-07151-8. According to the American Academy of Orthopaedic Surgeons' (AAOS) Complete Global Service Data Guide, 29888 includes the following procedures: minor synovial resection for visualization (e.g., 29875) articular shaving, debridement, chondroplasty (e.g., 29877, 29879) notchplasty (debridement of the intercondylar notch of the femur) ACL stump removal (replacement of ligament) synovectomy and fat-pad resection (e.g., 29875, 29876) intra-articular ligament reconstruction (e.g., 27428, 27558) harvesting of graft (20924) diagnostic arthroscopy (29870) additional portals or enlarging portals internal fixation of graft. Damage to the bone may make it difficult for the doctor to use standard total knee implants for revision knee replacement.
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