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. 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. 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. Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion-Based Rehabilitation Progression. 0000007124 00000 n eCollection 2022 Oct. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. For clinical responsibility, terminology, tips and additional info start codify free trial. 0000005244 00000 n 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. As soon as your pain begins to improve, stop taking opioids. In many areas, nonessential orthopaedic procedures that were postponed due to COVID-19 have resumed. 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. Revision total knee replacement is more complex and takes longer to perform than primary total knee replacement. 0000007066 00000 n Avoid soaking the wound in water until it has thoroughly sealed and dried. In some cases, there may be significant bone loss around the knee. For FREE Trial, Surgical Procedures on the Musculoskeletal System, Surgical Procedures on the Femur (Thigh Region) and Knee Joint, Repair, Revision, and/or Reconstruction Procedures on the Femur (Thigh Region) and Knee Joint, Copyright 2023. Recent reports have noted a 2% traumatic rupture rate of autogenous ACL reconstruction and a 15% rupture rate for allograft. Conclusion: Unfortunately, it's not always that straight forward. To break up scar tissue, your doctor may perform manipulation under anesthesia. 0000008849 00000 n Rarely, bone graft material may be used to help rebuild the knee. Severe tunnel dilatation, infection, or arthrofibrosis necessitates a two Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Proper rehabilitation after ACL surgery is critically important to the success of the reconstructive surgery. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, 237-241. hb``d`*g`` l,ALLLU'gyv8(q +Wn6d>]wZz&]=}#~ome.4Zz`9Wn){n3W%X33xCb:Q;YN Oy 4444--- Two small portions of hamstring tendon are harvested (autograft) to create the new ACL. International Perspective on Revision Anterior Cruciate Ligament Reconstruction: What Have We Been Missing? In either case, the implant was firmly fixed. All material on this website is protected by copyright. Your physical therapist will provide you with specific exercises to increase your strength and mobility and improve your ability to do everyday activities. 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. Copyright 2016 Elsevier B.V. All rights reserved. Correct me if I am mistaken. Epub 2011 Jun 6. Results: 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. 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. In a click, check the DRG's IPPS allowable, length of stay, and more. Price: $7,931 CPT Code: 29888 Anterior cruciate ligament reconstruction ( ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate He or she may also aspirate your knee. 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. 0000017565 00000 n Patient expectations must be tempered because functional outcomes and return to pre-injury sports are inferior to a primary surgery. "This is an obvious frustration to surgeons and coders " she adds "because the range of work in a repair versus a reconstruction is wide." Doing so indicates to the payer that extra work was performed above and beyond the normal scope of the procedure. 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. 0000005648 00000 n 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. 0000000016 00000 n 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. Although the procedure can be done by open repair, it is most often accomplished arthroscopically. 0000006602 00000 n You may need some help at home for several days to several weeks after discharge. Coding for arthroscopic reconstruction of anterior cruciate ligament (ACL) surgery. Reproduced from McAuley JP, Engh GA, Ammeen DJ: Treatment of the unstable total knee arthroplasty, in Instructional Course Lectures 53. Methods: Ten consecutive patients underwent autogenous bone grafting prior to ACL reconstruction revision (four females and six males, average age 28years). 305 102 Acta Chir Orthop Traumatol Cech. 2016 May 1;39(3):e456-64. Your doctor will talk with you about which option is best for you. Double Stage ACL Revision | Houston, Texas USA - ACL Injuries 0000004790 00000 n The site is secure. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. FOIA doi: 10.3928/01477447-20160324-01. Knee Surg Sports Traumatol Arthrosc. 0000020747 00000 n The femur (thighbone) has broken in several places around the implant. Epub 2016 Apr 5. 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. 0000004329 00000 n Sometimes a total knee replacement may not help you achieve the range of motion that is needed to perform everyday activities. 0000011499 00000 n 2021 Jan;37(1):195-205. doi: 10.1016/j.arthro.2020.08.031. 0000023425 00000 n This is then followed by intravenous antibiotics. 0000030828 00000 n An autograft is a graft of tissue from one point to another of the same individual's body. Ten consecutive patients underwent autogenous bone grafting prior to ACL reconstruction revision (four females and six males, average age 28years). An antibiotic spacer placed in the knee during the first stage of treatment for joint replacement infection. 0000002336 00000 n 8600 Rockville Pike 0000003323 00000 n Please enable it to take advantage of the complete set of features! 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. 0000002938 00000 n 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. When revisions include complexities like those listed above the coding option is to append modifier -22 (Unusual procedural services) to 29888. WebReconstruction of one or two ligaments not elsewhere specified: Pre Sept 2014: W7410: Multiple ligament reconstruction of knee (including posterior cruciate ligament) Pre Sept Advances in material science and plastic quality have made osteolysis less common today than in past decades. If knee instability cannot be treated through nonsurgical means such as bracing and physical therapy, revision surgery may be needed. 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. from the American Academy of Orthopaedic Surgeons, Questions and Answers for Patients Regarding Elective Surgery and COVID-19. 0000018637 00000 n Although more a staged procedure than a revisional procedure, we're including code 11970 [Replacement of tissue expander with permanent prosthesis] because it's often accompanied by revisional procedures 0000006284 00000 n You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. and transmitted securely. You may need a walker, cane, or crutches for the first few days or weeks until you are comfortable enough to walk without assistance. The ACL is located in the center of the knee, behind the kneecap, and runs from the femur to the tibia. 2016 May 1;39(3):e456-64. The https:// ensures that you are connecting to the eCollection 2022 Oct. Macchiarola L, Pizza N, Patania V, Grassi A, Dal Fabbro G, Marcacci M, Zaffagnini S. Knee Surg Sports Traumatol Arthrosc. (Left) In this tibial component, an additional block has been attached to make up for lost bone. Right knee arthroscopy, viewing from the anterolateral portal, knee is 30 flexion and valgus force applied. For these patients, there is a higher long-term risk that revision surgery will be needed due to loosening or wear. You will be asked to schedule a complete physical examination with your primary care doctor several weeks before revision surgery. During this time, you will also receive intravenous antibiotics. Please enable it to take advantage of the complete set of features! AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. Was the "AL" meant to be "ACL" or "ALL". For information:Questions and Answers for Patients Regarding Elective Surgery and COVID-19. An official website of the United States government. Over time, however, a knee replacement may fail for a variety of reasons. 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. Coding & Billing: Inside Breast Reconstructions and Revisions If you are admitted to the hospital, you may stay for several days. doi: 10.1016/j.eats.2020.08.024. And arthro-scopic ACL repair or reconstruction has only one code: 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction). 0000006363 00000 n Am J Sports Med. Preventing Blood Clots After Orthopaedic Surgery, Preventing Infection After Joint Replacement Surgery. 0000008780 00000 n Foot and ankle movement also is encouraged immediately following surgery to increase blood flow in your leg muscles to help prevent leg swelling and blood clots. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster. Depending on your condition, you may need to stay at a nursing facility or rehabilitation center for some time after you leave the hospital. 0000020410 00000 n 0000015728 00000 n Two small portions of hamstring tendon are harvested (autograft) to create the new ACL. Borchers JR, Kaeding CC, Pedroza AD, Huston LJ, Spindler KP, Wright RW; MOON Consortium and the MARS Group. This is needed to make sure that you are healthy enough to have the surgery and complete the recovery process. The spectrum of ACL failure includes symptoms of recurrent instability, pain, and/or stiffness. Arthroscopy. Two-Stage Revision Anterior Cruciate Ligament 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). Web1. Infection has to be ruled out prior to planning any reconstructive surgical procedure. This spacer is treated with antibiotics to fight the infection and will remain in your knee for several weeks. 0000068971 00000 n The implant may begin to lose its attachment to the bone. 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 8600 Rockville Pike Total knee replacement is one of the most successful procedures in all of medicine. A two-stage approach is recom-mended in cases of improper placement of the original The .gov means its official. NCI CPTC Antibody Characterization Program. Discussion: Determine how you would code this situation before looking at the [], Coding E/M visits in the orthopedic setting can be a struggle for even the most [], Billing for Casts,Strapping and Splinting, Two recent articles in Orthopedic Coding Alert contained advice on coding and billing for casting [], Use -77 When Two Physicians Perform Same Service, Modifier -77 (Repeat procedure by another physician) is reported when another physician repeats a procedure [], Question: I have an operative report for an excision of "bossing of the dorsal aspect [], Question: One of the surgeons in my practice coded an Akin procedure as 28310, but [], Question: Should I be using code 0014T (Meniscal transplantation, medial or lateral, knee [any method]) [], Question: We occasionally use Botox for trigger point injections for pain management. The possible risks and complications of revision surgery include: Managing Pain With Medications After Orthopaedic Surgery. ACL Osseous malalignment in the coronal or sagittal planes would also need correction along with or prior to revision ACL surgery. 0000007234 00000 n 0000022162 00000 n 2017 Mar;25(1):19-29. doi: 10.1097/JSA.0000000000000140. Tunnel Enlargement Correlates With Postoperative Posterior Laxity After Double-Bundle Posterior Cruciate Ligament Reconstruction. 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. The outputs are available to be used by all individual insurers and providers including CCSD and non-CCSD members. When it comes to ACL reconstruction surgery you have two main options, autograft and allograft. Measurement of bone mineral density in the tunnel regions for anterior cruciate ligament reconstruction by dual-energy X-ray absorptiometry, computed tomography scan, and the immersion technique based on Archimedes' principle. That would help in choosing 27427, 27428 & 27429. 27422 is what I use for MPFL reconstruction (dissection is carried to the vastus medialis muscle/tendon to where it attaches to the patella). Both can't be billed. The Codes 24707 (repair) and 27427, 8, & 9 (reconstruction/augmentation, intra or extra-articular) are for open procedures. 2 The recommended management for ACL tears in young active patients with functional instability following an ACL tear is ACLR. MeSH The average ORs were 81, 85 and 94%, and the average URs were 49, 75 and 89% at three, 12 and 24weeks, respectively. 0000034529 00000 n This information is provided as an educational service and is not intended to serve as medical advice. Associated meniscus tears and cartilage injuries are more common in revision than in primary surgery and need to be managed appropriately. Level of evidence: ACL They also have an MUE of one. Watch: Preventing Infection After Joint Replacement 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. 20 percent 30 percent) the procedure was as a result of this altered surgical field. Erickson BJ, Cvetanovich G, Waliullah K, Khair M, Smith P, Bach B Jr, Sherman S. Orthopedics. 0000005136 00000 n Before surgery, you will be evaluated by a member of the anesthesia team. CT examinations were performed at three, 12 and 24weeks after bone grafting. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). As the major stabilizing ligament of the knee, it prevents buckling and instability. During primary total knee replacement, the knee joint is replaced with an implant, or prosthesis, made of metal and plastic components. This second phase is usually performed approximately three By continuing to browse the site you are agreeing to our use of cookies. Prall WC, Kusmenkov T, Frmetz J, Haasters F, Mayr HO, Bcker W, Grote S. Injury. Bookshelf 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. A drain may be placed in your knee to collect any fluid or blood that may remain after surgery. He may also use a graft to reinforce the repair of the ligament. Arthroscopic ACL debridement | Medical Billing and 0000005488 00000 n Two-stage revisions are rarely performed, but are particularly useful when addressing substantial tunnel-widening, active CCSD - CCSD Schedule - Code Details - CCSD Schedule View the CPT code's corresponding procedural code and DRG. 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 This immune response also attacks the healthy bone around the implant, leading to a condition called osteolysis. Introduction: Of these, tunnel malposition and recurrent trauma are the most common causes. 2022 Sep 17;11(10):e1667-e1674. Two-Stage Revision Anterior Cruciate Ligament 0000004216 00000 n 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. Epub 2016 Apr 5. doi: 10.3928/01477447-20160324-01. Bookshelf Choose For My ACL Reconstruction Surgery 0000006441 00000 n Revision ACL reconstruction maybe performed as a one-stage or two-stage procedure. Doing so indicates to the payer that extra work was performed above and beyond the normal scope of the procedure. 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. 0000009928 00000 n I think AAOS was meant, not AAQOS. 0000005966 00000 n These may include special graded compression stockings, inflatable leg coverings (compression boots), and blood thinners. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. I've copied a piece of a C [QUOTE="Orthocoderpgu, post: 383507, member: 29238"]Does anyone know which ligaments are intra-articular & which are extra-articular? WebTwo-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review of Bone Graft Options for Tunnel Augmentation 2020 Mar;48 (3):767-777. doi: 0000009634 00000 n eCollection 2021 Jan. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. Search across Medicare Manuals, Transmittals, and more. 0000008438 00000 n In this procedure, you are given anesthesia so that you do not feel pain. <<0442EB843D58CB429143788B7DE0A388>]/Prev 973684>> Two-stage revision anterior cruciate ligament 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. Factors contributing to ACL failure may be classified as patient-related, surgeon-related, and biological factors. In some cases, only one implant or component of the prosthesis has to be revised. Two-stage revision anterior cruciate ligament reconstruction. He or she may recommend that you continue taking the blood-thinning and antibiotic medications that you started in the hospital. ACL reconstruction revision with staged bone grafting This may happen if excessive scar tissue has built up around the knee joint. 0000076786 00000 n 0000005887 00000 n PDF | Revision anterior cruciate ligament (ACL) reconstruction is substantially more challenging than primary reconstruction. Epub 2018 Dec 17. %%EOF 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. 0000004102 00000 n The surgeon should explain the specific complications he or she encountered (removal of graft material distant graft site etc.) In the case of allografts, a low level of immunologic reaction can weaken the graft and cause early failure as well. Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. 0000018169 00000 n Arthrosc Tech. Case series Level IV. sharing sensitive information, make sure youre on a federal Arthroscopic Bone Graft Technique for Two-Stage Revision Anterior Cruciate Ligament Reconstruction. Before And arthro-scopic ACL repair or reconstruction has only one code: 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction). Sometimes, however, the knee remains stiff. The site is secure. 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. 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. Epub 2016 Dec 30. 0000012729 00000 n Reproduced from Parvizi J, Azzam K: Periprosthetic fractures about the knee, American Academy of Orthopaedic Surgeons website: Orthopaedic Knowledge Online Journal, 2008. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. 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 determining the extent of the revision needed, your doctor will consider several factors, including the quality of the remaining bone, the type and location of the fracture, and whether the implant is loose. 0000104055 00000 n An emerging procedure, thermal ACL shrinkage, is used to stretch injuries of the ligament that do not require tendon graft. 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. 0000004907 00000 n This site needs JavaScript to work properly. 2022 Mar 11;10(3):23259671221083318. doi: 10.1177/23259671221083318. WebAim: To quantify healing of tibial bone tunnels after bone grafting in two-stage ACL reconstruction revision. The average BMD was 510 and 571mg/cm(3) at 12 and 24weeks, respectively, with a significantly higher value at 24weeks. Careers. 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. A periprosthetic fracture is a broken bone that occurs around the components of a total knee replacement. An ACL injury can be relatively minor, such as a pull or stretch, or severe, where the ligament is partially torn or completely ruptured. 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. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). These fractures are most often the result of a fall, and usually require revision surgery. An emerging procedure, thermal ACL shrinkage, is used to stretch injuries of the ligament that do not require tendon graft. 2021 Oct 12;11(4):e20.00055. Also, patients who are younger when they undergo the initial knee replacement may "outlive" the life expectancy of their artificial knee. When the infection has been cleared, your doctor will perform a second surgery to remove the antibiotic spacer and insert a new prosthesis. In a 2-stage surgery, the implant is removed, the joint is washed out, and a temporary cement spacer is placed in your knee. To determine whether you have an infection, your doctor may order blood tests. I'm not sure what code was meant to be billed with 27427 for the Lemaire. presence of scar tissue complicating the surgical dissection. American Hospital Association ("AHA"), Posterolateral Corner Reconstruction Knee. In this procedure, joint fluid is removed using a needle and syringe, then analyzed in a laboratory to determine if infection is present. Bethesda, MD 20894, Web Policies The ACL is located in the center of the knee, behind the kneecap, and runs from the femur to the tibia. 0000007002 00000 n 0000014533 00000 n Bone Incorporation of Silicate-Substituted Calcium Phosphate in 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Histologic and Radiographic Study. 2023 Feb;31(2):559-571. doi: 10.1007/s00167-022-07197-8. ACL If extensive scar tissue or the position of the components in your knee is limiting your range of motion, revision surgery may be needed.