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. 0000004444 00000 n neurilemma), Release of entrapment of deeply placed peripheral nerve, Local anaesthetic blockade of named major nerve or plexus, Injection into subcutaneous tissue/painful trigger point under local anaesthetic, Two or more injections into subcutaneous tissue/painful trigger point under local anaesthetic, Tendon sheath injection of therapeutic substance including Viscosupplement +/- image guidance, Tendon graft, or tendon transfer (as sole procedure, not otherwise specified), Delayed or secondary repair of tendon (including graft, transfer and/or prosthesis) (not otherwise specified), Tenolysis, of extensor (not otherwise specified), Lengthening of tendon(s) or open tenotomy, Release of constriction of sheath of tendon (e.g. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. eCollection 2021 Oct-Dec. Tachibana Y, Tanaka Y, Kinugasa K, Mae T, Horibe S. Orthop J Sports Med. In some cases, only one implant or component of the prosthesis has to be revised. If cement was used in the primary total knee replacement, this is removed, as well. eCollection 2021 Jan. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. The surgeon should explain the specific complications he or she encountered (removal of graft material distant graft site etc.) 0000005887 00000 n 0000003323 00000 n As with every use of an unlisted procedure code documentation should include a thorough description of the procedure an operative note and a letter from the surgeon.". 0000014223 00000 n 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. For information:Questions and Answers for Patients Regarding Elective Surgery and COVID-19. 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. After removing the original implant, your doctor will prepare the bone surfaces for the revision implant. This information is provided as an educational service and is not intended to serve as medical advice. Copyright 2016 Elsevier B.V. All rights reserved. Correct me if I am mistaken. Clipboard, Search History, and several other advanced features are temporarily unavailable. The outputs are available to be used by all individual insurers and providers including CCSD and non-CCSD members. With two exceptions HCPCS code G0289 (Surgical knee arthroscopy for removal of loose body, foreign body, debridement/shaving of articular cartilage at the time Keywords: Two-Stage Revision Anterior Cruciate Ligament A drain may be placed in your knee to collect any fluid or blood that may remain after surgery. Because of the already surgically altered operative field ACL revisions are more complex than repairs or reconstructions. It is a longer, more complex procedure that requires extensive planning, and specialized implants and tools to achieve a good result. 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. For clinical responsibility, terminology, tips and additional info start codify free trial. You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. doi: 10.1016/j.eats.2020.08.024. 0000068971 00000 n The ACL is located in the center of the knee, behind the kneecap, and runs from the femur to the tibia. 2023. 0000004907 00000 n A two-stage 0000002336 00000 n 2021 Oct 12;11(4):e20.00055. MeSH In the case of allografts, a low level of immunologic reaction can weaken the graft and cause early failure as well. You may need a walker, cane, or crutches for the first few days or weeks until you are comfortable enough to walk without assistance. Rotator Cuff and Shoulder Conditioning Program. Bethesda, MD 20894, Web Policies Clipboard, Search History, and several other advanced features are temporarily unavailable. 0000018637 00000 n ACL Arthroscopy. 0000030828 00000 n ACL Laboratory tests. National Library of Medicine 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. Pandey V, Madi S, Thonse C, Joseph C, Rajan D, Varughese J, Thilak J, Jayaprasad PS, Acharya K, Ramamurthy KG, Reddy R, Amravathi R, Rao S, Gangavarapu S, Srinivas M, Jose S, Sundararjan SR. Indian J Orthop. 0000005136 00000 n In the vast majority of cases, it enables people to live richer, more active lives free of chronic knee pain. 0000017739 00000 n 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. 0000021025 00000 n Before 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. Over time, however, a knee replacement may fail for a variety of reasons. And arthro-scopic ACL repair or reconstruction has only one code: 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction). official website and that any information you provide is encrypted 2 The recommended management for ACL tears in young active patients with functional instability following an ACL tear is ACLR. 2016 May 1;39(3):e456-64. It is rare to do them "Open." 0000002938 00000 n Erickson BJ, Cvetanovich G, Waliullah K, Khair M, Smith P, Bach B Jr, Sherman S. Orthopedics. Accessed May 2015. 0000023425 00000 n hb``d`*g`` l,ALLLU'gyv8(q +Wn6d>]wZz&]=}#~ome.4Zz`9Wn){n3W%X33xCb:Q;YN Oy 4444--- and estimate how much more difficult (e.g. ACL reconstruction revision with staged bone grafting Epub 2016 Apr 5. and transmitted securely. We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. Borchers JR, Kaeding CC, Pedroza AD, Huston LJ, Spindler KP, Wright RW; MOON Consortium and the MARS Group. Accessibility Unable to load your collection due to an error, Unable to load your delegates due to an error. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, 237-241. 0000004216 00000 n The average ORs, URs and BMD at 24weeks after bone grafting were higher than those at 12weeks, which suggests that at 24weeks after bone grating, the condition of the patients' beds becomes favorable for safe implantation and fixation of ACL graft revision. (Right) In revision surgery, components with longer stems fit more securely into the bones and provide stability. In order for a total knee replacement to function properly, an implant must remain firmly attached to the bone. Federal government websites often end in .gov or .mil. Before In all three methods, the new tendon is inserted through holes drilled in the tibia and femur, pulled through, and secured in position with bio-absorbable or metal screws. Individuals who ski, play football or in-line skate frequently injure themselves in this manner. 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. Economic Reliable Technique for Tunnel Grafting Using Iliac Crest Bone Graft in Two-Staged Revision Anterior Cruciate Ligament Surgery. An autograft is a graft of tissue from one point to another of the same individual's body. The ACL is located in the center of the knee, behind the kneecap, and runs from the femur to the tibia. Web1. ACL This percentage will help the payer to determine what extra percentage of the normal fee to reimburse for the extra work. Conclusion: 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. For patients whose procedures have not yet been rescheduled:What to Do If Your Orthopaedic Surgery Is Postponed. 0000004329 00000 n A suture beneath your skin will not require removal. Evaluations were performed on 15 axial planes at one-millimeter intervals from the articular surface perpendicular to the long axis of the tibia using the following three parameters: occupying ratio (OR), union ratio (UR), and bone mineral density (BMD) of grafted bone. Tunnel widening is generally cavitary, frequently maximal Infection may occur while you are in the hospital or after you go home. What Is ACL? With arthroscopic guidance, a thermal probe is inserted into the knee, where it heats the damaged ligament to shrink and tighten it. Keywords: 305 102 (Top): Examples of metal augments that can be added to implants to make up for lost bone. Coding ACL Knee Surg Relat Res. 0000024645 00000 n Sometimes, however, the knee remains stiff. If knee instability cannot be treated through nonsurgical means such as bracing and physical therapy, revision surgery may be needed. As the major stabilizing ligament of the knee, it prevents buckling and instability. Meet the Coding Challenges of ACL Reconstruction and Revision, AMA,AAOS Offer Advice for Using New Codes for Bankart and SLAP Lesion Repairs, " There are several methods by which a physician can achieve anterior cruciate ligament (ACL) [], Test your coding knowledge. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. Combat the #1 denial reason - mismatched CPT-ICD-9 codes - with top Medicare carrier and private payer accepted diagnoses for the chosen CPT code. AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. 305 0 obj <> endobj Double Stage ACL Revision | Houston, Texas USA - ACL Injuries Two-Stage Revision Anterior Cruciate Ligament Reconstruction. 0000006842 00000 n Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Limited Coding Options Several codes describe open ACL repair and reconstruction, but with the advent and domination of arthroscopy, the codes are largely obsolete. During ACL reconstruction, the surgeon removes the damaged ligament and replaces it with a segment of tendon tissue similar to a ligament that connects muscle to bone. Conclusion: Removing this cement from the bone is a time-consuming process that adds to the complexity and length of the revision surgery. 0000020410 00000 n This is then followed by intravenous antibiotics. Epub 2016 Dec 30. If this occurs, metal augments and platform blocks can be added to the main components to make up for the bony deficits. Your doctor's office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at home. (Left) In this tibial component, an additional block has been attached to make up for lost bone. In this procedure, you are given anesthesia so that you do not feel pain. Federal government websites often end in .gov or .mil. CCSD - CCSD Schedule - Code Details - CCSD Schedule The scarcity of codes for the ACL repair reveals the reimbursement challenge. Quadriceps) (involving large joint), Partial excision of bone (including exostoses), Osteotomy of long bone, +/- fixation (including graft), Removal of internal fixation from bone / joint, excluding K-wires +/- image guidance, Implantation of autologous chondrocytes into knee (including knee surgery, debridement and periosteal flap or membrane cover), Reconstruction of one or two ligaments not elsewhere specified, Multiple ligament reconstruction of knee (including posterior cruciate ligament), Reconstruction of lateral collateral ligament complex, Allograft anterior cruciate ligament reconstruction, 2 stage revision anterior cruciate ligament reconstruction - first stage, 2 stage revision anterior cruciate ligament reconstruction - second stage, Revision of anterior cruciate ligament reconstruction including autograft/allograft, Open surgical stabilisation of patella, including soft tissue/tendon transfer or release, +/- application of cast (adult), Open surgical stabilisation of patella, including soft tissue/tendon transfer or release, +/- application of cast (child), Open excision of calcific deposit (e.g. See this image and copyright information in PMC. government site. This site needs JavaScript to work properly. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Reproduced from Parvizi J, Azzam K: Periprosthetic fractures about the knee, American Academy of Orthopaedic Surgeons website: Orthopaedic Knowledge Online Journal, 2008. Revision for infection can be done in one of two ways, depending on the type of bacteria, how long the infection has been present, the degree of infection, and patient preferences. Depending on your condition, you may need to stay at a nursing facility or rehabilitation center for some time after you leave the hospital. Osti L, Buda M, Osti R, Massari L, Maffulli N. Sports Med Arthrosc Rev. Methods: Ten consecutive patients underwent autogenous bone grafting prior to ACL reconstruction revision (four females and six males, average age 28years). 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 An official website of the United States government. Extraarticular ligaments are the ligaments located outside the knee joint. shoulder, hip), Arthroscopic meniscectomy (including debridement), Partial replacement of the meniscus of the knee using a biodegradable scaffold, Arthroscopic meniscectomy (including debridement) - bilateral, Therapeutic arthroscopy operation on articular cartilage (other than W8200 and W8230) (as sole procedure), Repair of knee ligaments (open or arthroscopic), Multiple arthroscopic operation on knee (including meniscectomy, chondroplasty, drilling or microfracture), Arthroscopy of knee (including examination under anaesthetic, washout and biopsy) (as sole procedure), Multiple arthroscopic operation on knee (including meniscectomy, chondroplasty, drilling or microfracture) - bilateral, Therapeutic arthroscopy operation on cavity of joint (not otherwise specified) (as sole procedure), Therapeutic arthroscopy operation on cavity of joint - bilateral (not otherwise specified) (as sole procedure), Diagnostic arthroscopic examination of joint, +/- biopsy (not otherwise specified) (as sole procedure), Therapeutic local anaesthetic/aspiration- large joint - single, Therapeutic local anaesthetic/aspiration- large joint - more than 1 joint, Therapeutic local anaesthetic/aspiration- small joint - single, Therapeutic local anaesthetic/aspiration- small joint - more than 1 joint, Therapeutic local anaesthetic/aspiration of joint under imaging control, Injection(s) +/- aspiration, into joint, cyst, bursa with image guidance - unilateral, Injection(s) +/- aspiration, into joint, cyst, bursa - unilateral, Examination/ manipulation of joint under general anaesthetic +/- injection +/- arthrogram (as sole procedure), Intramuscular injection(s) with x-ray control (e.g. 0000011499 00000 n If an artificial joint becomes infected, it may become stiff and painful. Before your surgery, your doctor will discuss each of the risks with you and will take specific measures to help avoid potential complications. In a primary total knee replacement, the surfaces of the femur, tibia, and patella are replaced with implants. You may need some help at home for several days to several weeks after discharge. 0000006762 00000 n Subscribe to. Epub 2011 Jun 6. Tunnel Enlargement Correlates With Postoperative Posterior Laxity After Double-Bundle Posterior Cruciate Ligament Reconstruction. In either case, the implant was firmly fixed. WebReconstruction of one or two ligaments not elsewhere specified: Pre Sept 2014: W7410: Multiple ligament reconstruction of knee (including posterior cruciate ligament) Pre Sept Instr Course Lect. PMC Before surgery, you will be evaluated by a member of the anesthesia team. 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. Your doctor may prescribe one or more measures to prevent blood clots and decrease leg swelling. If you are admitted to the hospital, you may stay for several days. Bone Incorporation of Silicate-Substituted Calcium Phosphate in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic and Radiographic Study. Arthrosc Tech. Two-stage revision anterior cruciate ligament Unfortunately, it's not always that straight forward. When the tendon is harvested from the patient, harvesting takes place at the same time as the reconstructive surgery. 0000034529 00000 n Revision ACL Reconstruction: Principles and Practice - PubMed To determine whether you have an infection, your doctor may order blood tests. 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 After you wake up, you will be taken to your hospital room. Aim: 8600 Rockville Pike 09/12/2018 00:00:00 to 23/12/2018 00:00:00, This site uses cookies. official website and that any information you provide is encrypted A periprosthetic fracture is a broken bone that occurs around the components of a total knee replacement. 0000006205 00000 n Other times, all three componentsfemoral, tibial, and patellarneed to removed or replaced and the bone around the knee needs to be rebuilt with augments (metal pieces that substitute for missing bone) or bone graft. 8600 Rockville Pike Am J Sports Med. The implant may begin to lose its attachment to the bone. Watch: Preventing Infection After Joint Replacement Surgery. Reproduced from Daines BK, Dennis DA: Management of Bone Defects in Revision Total Knee Arthroplasty. Epub 2016 Apr 5. 2023 Jan;31(1):340-348. doi: 10.1007/s00167-022-07151-8. Epub 2022 Sep 7. %%EOF Ziegler CG, DePhillipo NN, Kennedy MI, Dekker TJ, Dornan GJ, LaPrade RF. Double-bundle non-anatomic ACL revision reconstruction with allograft resulted in a low revision rate at 10years. Arthrosc Tech. The Codes 24707 (repair) and 27427, 8, & 9 (reconstruction/augmentation, intra or extra-articular) are for open procedures. As with every use of an unlisted procedure code documentation should include a thorough description of the procedure an operative note and a letter from the surgeon. 0000103679 00000 n 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. 0000102698 00000 n Rarely, bone graft material may be used to help rebuild the knee. Osseous malalignment in the coronal or sagittal planes would also need correction along with or prior to revision ACL surgery. The risk of infection is slightly higher after revision surgery than after primary total knee replacement. JOSPT 2012 When revisions include complexities like those listed above the coding option is to append modifier -22 (Unusual procedural services) to 29888. 0000006521 00000 n In most cases, he or she will use specialized implants with longer, thicker stems that fit deeper inside the bone for extra support. 2012 Oct;28(10):1464-71. doi: 10.1016/j.arthro.2012.04.053. Reconstruction of a torn ACL is significantly more involved and is accomplished through one of three methods, all of them arthroscopic: In all three methods, the new tendon is inserted through holes drilled in the tibia and femur, pulled through, and secured in position with bio-absorbable or metal screws. 0000014533 00000 n 0000005349 00000 n In complex cases, the surgery may take several hours. 0000005966 00000 n eCollection 2022 Oct. Macchiarola L, Pizza N, Patania V, Grassi A, Dal Fabbro G, Marcacci M, Zaffagnini S. Knee Surg Sports Traumatol Arthrosc. Your physical therapist will provide you with specific exercises to increase your strength and mobility and improve your ability to do everyday activities. These may include special graded compression stockings, inflatable leg coverings (compression boots), and blood thinners. 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. Unauthorized use of these marks is strictly prohibited. 0000005807 00000 n ACL Reconstruction For practical purposes, in this day and time, all ACL Reconstructions are done Arthroscopically (or Arthroscopically Assisted). 0000005244 00000 n government site. 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. Knee Surg Sports Traumatol Arthrosc. Recent reports have noted a 2% traumatic rupture rate of autogenous ACL reconstruction and a 15% rupture rate for allograft. Two-stage revisions are rarely performed, but are particularly useful when addressing substantial tunnel-widening, active The femur (thighbone) has broken in several places around the implant. Opioid dependency and overdose have become critical public health issues in the U.S. 0000007234 00000 n 0000008438 00000 n After surgery, you will be moved to the recovery room, where you will remain for several hours while your recovery from anesthesia is monitored. 0000102999 00000 n Several codes describe open ACL repair and reconstruction, but with the advent and domination of arthroscopy, the codes are largely obsolete. trigger finger), Trigger point injection/Enthesis - 1 injection, Major release of muscle for pain or contracture (e.g. 0000075493 00000 n Reproduced from McAuley JP, Engh GA, Ammeen DJ: Treatment of the unstable total knee arthroplasty, in Instructional Course Lectures 53. 2017 Apr;33(4):819-827. doi: 10.1016/j.arthro.2016.10.007. Also, patients who are younger when they undergo the initial knee replacement may "outlive" the life expectancy of their artificial knee. 0000006046 00000 n ACL problems are typically the result of pivoting, twisting, hyperflexion and hyperextension injuries to the knee. 0000003488 00000 n Reduced range of motion or stiffness in the knee, Infection in the wound or the new prosthesis, Blood clots in the legs, which may travel to the lungs (pulmonary embolism), Medical problems such as heart attack, lung complications, or stroke. 0000013979 00000 n WebAim: To quantify healing of tibial bone tunnels after bone grafting in two-stage ACL reconstruction revision. 27427 Which ligamens are intra-articular and which are extra-articular. Although the procedure can be done by open repair, it is most often accomplished arthroscopically. ACL surgery is defined by CPT 29888 (Arthroscopically aided anterior cruciate ligament (The patellar component is not shown here.). 0000017278 00000 n Total knee replacement is one of the most successful procedures in all of medicine. 0000006441 00000 n There are different types of revision surgery. Revision Anterior Cruciate Ligament Surgery: One-Stage versus An autogenous iliac bone block was driven into a new tunnel. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. 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. To break up scar tissue, your doctor may perform manipulation under anesthesia. b0O &a`6 a@5gHGq:XDA T@=|/C C {0+Pj`m- A1/.NM321bpQUa)o.. DYf31|bncXre3Omia@3$3d`Nh>CM+-|{ 4aBT84_3- b5 ~Tk6H30VCLa7fYL C This immune response also attacks the healthy bone around the implant, leading to a condition called osteolysis. Revision ACL surgery: A comprehensive approach - Mayo Damage to the bone may make it difficult for the doctor to use standard total knee implants for revision knee replacement. Once the incision is made, the doctor will move the kneecap and tendons to the side to reveal your knee joint. Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion-Based Rehabilitation Progression. Coding for arthroscopic reconstruction of anterior cruciate ligament (ACL) surgery. Web1. Many types of medicines are available to help manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. The doctor then bends your knee in an attempt to break up the scar tissue. 0000007002 00000 n [BTB allograft for revision surgery of the anterior cruciate ligament - part 2]. An ACL injury can be relatively minor, such as a pull or stretch, or severe, where the ligament is partially torn or completely ruptured. The Danish registry recently published a report indicating that 3% of all ACL reconstructions were revised within the first 2 years. 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. trailer %PDF-1.7 % M23.611 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 2005;72(5):297-303. FOIA and transmitted securely. eCollection 2022 Mar. After surgery, you will feel some pain. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. 2022 Aug 20;56(10):1703-1716. doi: 10.1007/s43465-022-00719-z. Unable to load your collection due to an error, Unable to load your delegates due to an error, Etiological factors responsible for failure of an anterior cruciate ligament failure (, Right knee arthroscopy, viewing from the anterolateral portal, knee in 90 flexion. 0000019179 00000 n Two-stage revision ACLR should be considered in cases of tunnel lysis, infection, malalignment, meniscal deficiency, or chondral lesions. Adams D, Logerstedt D, et al. 2017 Feb 15;66:543-556. CPT Code 27429 - Repair, Revision, and/or Reconstruction 2021 Jan 29;9(1):2325967120977834. doi: 10.1177/2325967120977834. Severe tunnel dilatation, infection, or arthrofibrosis necessitates a two-stage approach. 0000004102 00000 n Please note that: Procedure Codes Schedule Arthroscopic ACL debridement | Medical Billing and The incision may be longer than the original, however, to allow the old components to be removed. He may also use a graft to reinforce the repair of the ligament. 0000104055 00000 n 0000103797 00000 n Factors contributing to ACL failure may be classified as patient-related, surgeon-related, and biological factors. I think 27558 more appropriate. Removing the implant leads to a higher chance of curing the infection, but is associated with a longer recovery.