cpt code for two stage acl reconstruction cpt code for two stage acl reconstruction

0000008179 00000 n View any code changes for 2023 as well as historical information on code creation and revision. " There are several methods by which a physician can achieve anterior cruciate ligament (ACL) revision or reconstruction, but only two codes to describe them. Epub 2016 Dec 30. 2 The recommended management for ACL tears in young active patients with functional instability following an ACL tear is ACLR. 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. 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 WebAim: To quantify healing of tibial bone tunnels after bone grafting in two-stage ACL reconstruction revision. This information is provided as an educational service and is not intended to serve as medical advice. The spectrum of ACL failure includes symptoms of recurrent instability, pain, and/or stiffness. 2019 Feb;50(2):467-475. doi: 10.1016/j.injury.2018.12.020. 0000006762 00000 n 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. 2017 Apr;33(4):819-827. doi: 10.1016/j.arthro.2016.10.007. In most cases, this procedure is successful in improving range of motion. It is important to continue moving and exercising your knee when you are home. 0000014223 00000 n 15 Historically, the failure rate of 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. You will either be admitted to the hospital on the day of surgery or you will go home the same day. I think AAOS was meant, not AAQOS. 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. Accessibility Damage to the bone may make it difficult for the doctor to use standard total knee implants for revision knee replacement. 2012 Oct;28(10):1464-71. doi: 10.1016/j.arthro.2012.04.053. method is a great way to manage these symptoms:Rest: Like any surgery, rest is an extremely important part of the recovery process. Ice: Apply ice to the repaired knee at least once every two hours. Aim for sessions of 20 minutes at a time.Compression: Use a compression wrap or elastic bandage around the knee.Elevation: Elevate the knee whenever possible. Arthroscopy. To determine whether you have an infection, your doctor may order blood tests. This is needed to make sure that you are healthy enough to have the surgery and complete the recovery process. 0000018169 00000 n Doing so indicates to the payer that extra work was performed above and beyond the normal scope of the procedure. 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. Doing so indicates to the payer that extra work was performed above and beyond the normal scope of the procedure. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. This is a natural part of the healing process. Discussion: Unauthorized use of these marks is strictly prohibited. 0000004329 00000 n official website and that any information you provide is encrypted Anterior cruciate ligament; Anterior cruciate ligament reconstruction; Autograft; One-stage reconstruction; Posterior tibial slope; Re-tear; Revision; Tunnel dilatation; Tunnel malposition; Two-stage reconstruction. The graft may come from your own bone (autograft) or from a donor (allograft). Bookshelf The Codes 24707 (repair) and 27427, 8, & 9 (reconstruction/augmentation, intra or extra-articular) are for open procedures. 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. 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. Please enable it to take advantage of the complete set of features! Donor tendon, or allograft, is used to create the new ACL. Epub 2012 Aug 2. von Recum J, Schwaab J, Guehring T, Grtzner PA, Schnetzke M. Arthroscopy. Two-Stage Revision Anterior Cruciate Ligament Reconstruction. startxref Advances in material science and plastic quality have made osteolysis less common today than in past decades. This second phase is usually performed approximately three Disclaimer. Double-bundle non-anatomic ACL revision reconstruction with allograft resulted in a low revision rate at 10years. To begin, your doctor will follow the line of the incision made during your primary total knee replacement. Two small portions of hamstring tendon are harvested (autograft) to create the new ACL. You will be asked to schedule a complete physical examination with your primary care doctor several weeks before revision surgery. 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.". Reproduced from Parvizi J, Azzam K: Periprosthetic fractures about the knee, American Academy of Orthopaedic Surgeons website: Orthopaedic Knowledge Online Journal, 2008. Both can't be billed. 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. If an artificial joint becomes infected, it may become stiff and painful. 09/12/2018 00:00:00 to 23/12/2018 00:00:00, This site uses cookies. 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. Careers. 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. Recent reports have noted a 2% traumatic rupture rate of autogenous ACL reconstruction and a 15% rupture rate for allograft. The anesthesia team, with your input, will determine which type of anesthesia will be best for you. In osteolysis, the bone around the implant deteriorates, making the implant loose or unstable. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. If this occurs, metal augments and platform blocks can be added to the main components to make up for the bony deficits. and transmitted securely. Patient expectations must be tempered because functional outcomes and return to pre-injury sports are inferior to a primary surgery. Borchers JR, Kaeding CC, Pedroza AD, Huston LJ, Spindler KP, Wright RW; MOON Consortium and the MARS Group. Case series Level IV. 0000007066 00000 n In a 2-stage surgery, the implant is removed, the joint is washed out, and a temporary cement spacer is placed in your knee. 2021 Oct 12;11(4):e20.00055. Sometimes a total knee replacement may not help you achieve the range of motion that is needed to perform everyday activities. Reproduced from Daines BK, Dennis DA: Management of Bone Defects in Revision Total Knee Arthroplasty. Many types of medicines are available to help manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. doi: 10.3928/01477447-20160324-01. All material on this website is protected by copyright. Over time, however, a knee replacement may fail for a variety of reasons. In a primary total knee replacement, the surfaces of the femur, tibia, and patella are replaced with implants. 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." Instr Course Lect. trailer 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. 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. WebIntrinsic failure of the graft can occur from graft impingement or trauma. eCollection 2022 Mar. 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. 2011 Sep;39(9):1889-93. doi: 10.1177/0363546511406871. Ansari MH, Claes S, Wascher DC, Neyret P, Stuart MJ, Krych AJ. 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. In either case, the implant was firmly fixed. WebThe quadriceps tendon autograft is often used for primary (initial) reconstruction as well as revision (repeat) reconstruction 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), 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. 0000018637 00000 n This replacement tissue is called a graft. doi: 10.3928/01477447-20160324-01. Preoperative Planning for ACL Revision Surgery. Epub 2016 Apr 5. After removing the original implant, your doctor will prepare the bone surfaces for the revision implant. 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. Epub 2011 Jun 6. %PDF-1.7 % Bethesda, MD 20894, Web Policies The average BMD was 510 and 571mg/cm(3) at 12 and 24weeks, respectively, with a significantly higher value at 24weeks. 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. An autograft is a graft of tissue from one point to another of the same individual's body. 0000006125 00000 n JOSPT 2012 ACL surgery is defined by CPT 29888 (Arthroscopically aided anterior cruciate ligament 0000020410 00000 n 0000005015 00000 n You may experience recurrent swelling and the sense that your knee is "giving way." In this procedure, joint fluid is removed using a needle and syringe, then analyzed in a laboratory to determine if infection is present. Arthrosc Tech. PDF | Revision anterior cruciate ligament (ACL) reconstruction is substantially more challenging than primary reconstruction. Arthroscopic Bone Graft Technique for Two-Stage Revision Anterior Cruciate Ligament Reconstruction. 0000024645 00000 n 0000068971 00000 n 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. The outputs are available to be used by all individual insurers and providers including CCSD and non-CCSD members. Opioid dependency and overdose have become critical public health issues in the U.S. The site is secure. Would you like email updates of new search results? When the tendon is harvested from the patient, harvesting takes place at the same time as the reconstructive surgery. Tunnel Enlargement Correlates With Postoperative Posterior Laxity After Double-Bundle Posterior Cruciate Ligament Reconstruction. Intraarticular ligaments are the ligaments located inside the knee joint. The femur (thighbone) has broken in several places around the implant. 0000076190 00000 n If this occurs, your doctor may attempt "manipulation under anesthesia.". You will also work with your therapist to ensure that you can straighten your leg and then bend your knee to at least 90 degrees of flexion. Methods: Ten consecutive patients underwent autogenous bone grafting prior to ACL reconstruction revision (four females and six males, average age 28years). 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. Would you like email updates of new search results? If necessary, your doctor will remove the orginal implant very carefully to preserve as much bone as possible. For patients whose procedures have not yet been rescheduled:What to Do If Your Orthopaedic Surgery Is Postponed. 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. As soon as your pain begins to improve, stop taking opioids. 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. 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 Medications are often prescribed for short-term pain relief after surgery. 2022 May 8;34(1):24. doi: 10.1186/s43019-022-00153-3. 0000076243 00000 n (The patellar component is not shown here.). With arthroscopic guidance, a thermal probe is inserted into the knee, where it heats the damaged ligament to shrink and tighten it. Your doctor will talk with you about which option is best for you. As the major stabilizing ligament of the knee, it prevents buckling and instability. Short description: Oth spon disrupt of anterior cruciate ligament of right knee The 2023 edition of ICD-10-CM M23.611 became effective on October 1, 2022. PMC One of the most serious complications facing patients who undergo revision surgery is infection. Rotator Cuff and Shoulder Conditioning Program. Your surgeons codes have an issue in that they hit an edit. Two-Stage Revision Anterior Cruciate Ligament Reconstruction. I'm not sure if I'm coding this correctly, so I could really use some advice. 0000006205 00000 n from the American Academy of Orthopaedic Surgeons, Questions and Answers for Patients Regarding Elective Surgery and COVID-19. M23.611 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. 20 percent 30 percent) the procedure was as a result of this altered surgical field. (Left) In this tibial component, an additional block has been attached to make up for lost bone. 0000008849 00000 n 0000032820 00000 n Several codes describe open ACL repair and reconstruction, but with the advent and domination of arthroscopy, the codes are largely obsolete. This may happen if excessive scar tissue has built up around the knee joint. In a click, check the DRG's IPPS allowable, length of stay, and more. To break up scar tissue, your doctor may perform manipulation under anesthesia. American Hospital Association ("AHA"). It is important to use opioids only as directed by your doctor. There are different types of revision surgery. Reproduced from McAuley JP, Engh GA, Ammeen DJ: Treatment of the unstable total knee arthroplasty, in Instructional Course Lectures 53. Was the "AL" meant to be "ACL" or "ALL". You may need a walker, cane, or crutches for the first few days or weeks until you are comfortable enough to walk without assistance. 0000005648 00000 n The stitches or staples will be removed several weeks after surgery. Watch: Preventing Infection After Joint Replacement Surgery. 0000002336 00000 n He or she may also aspirate your knee. Although infection occurs in only a small percentage of patients, it can prolong or limit full recovery. ACL Reconstruction For practical purposes, in this day and time, all ACL Reconstructions are done Arthroscopically (or Arthroscopically Assisted). That would help in choosing 27427, 27428 & 27429. An antibiotic spacer placed in the knee during the first stage of treatment for joint replacement infection. 305 102 0000006441 00000 n While the ligament is a good starting point, you must also take into consideration the type of repair being performed. Infection may occur while you are in the hospital or after you go home. The https:// ensures that you are connecting to the Removing the implant leads to a higher chance of curing the infection, but is associated with a longer recovery. Before ACL reconstruction revision; Bone healing; Bone mineral density; Iliac bone grafting; Two-staged ACL reconstruction revision. In this procedure, you are given anesthesia so that you do not feel pain. 0000006521 00000 n Epub 2016 Apr 5. 0000103679 00000 n 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 0000008780 00000 n After surgery, you will feel some pain. 0000004557 00000 n 0000006842 00000 n 2021 Jan 29;9(1):2325967120977834. doi: 10.1177/2325967120977834. With arthroscopic guidance, a thermal probe is inserted into the knee, where it heats the damaged ligament to shrink and tighten it. WebThere are two types of staged surgery: In a 2-stage surgery, the implant is removed, the joint is washed out, and a temporary cement spacer is placed in your knee. 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. And arthro-scopic ACL repair or reconstruction has only one code: 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction). Two-stage revision anterior cruciate ligament reconstruction. The stretched ligament shrinks to its normal size, thus returning stability to the knee. Does anyone know which ligaments are intra-articular & which are extra-articular? Malpositioned femoral tunnel (shown with chondral pick) above the intercondylar ridge (dotted line) seen during revision surgery. My predecessor coded [], Copyright 2023. 0000000016 00000 n 5. The doctor then bends your knee in an attempt to break up the scar tissue. 0000005887 00000 n The ACL is located in the center of the knee, behind the kneecap, and runs from the femur to the tibia. Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. Your physical therapist will provide you with specific exercises to increase your strength and mobility and improve your ability to do everyday activities. Outcomes of Combined Lateral Meniscus Posterior Root Repair and Anterior Cruciate Ligament Reconstruction. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2023. 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. WebThe second stage of the double-stage ACL revision reconstruction is reconstructing the ACL with a new graft. It may also feel stiff or unstable, making it difficult to perform your everyday activities. 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). 0000005488 00000 n eCollection 2020 Dec. Knee Surg Relat Res. 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. 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. When revisions include complexities like those listed above the coding option is to append modifier -22 (Unusual procedural services) to 29888. 0000009928 00000 n Register Online, Autograft anterior cruciate ligament reconstruction (including arthroscopic and meniscectomy), Excision of lesion of peripheral nerve (e.g. Associated meniscus tears and cartilage injuries are more common in revision than in primary surgery and need to be managed appropriately. Federal government websites often end in .gov or .mil. These coding principles set out how the authors intend that the codes and narratives within the CCSD Schedule are interpreted and used. 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 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. 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. In the vast majority of cases, it enables people to live richer, more active lives free of chronic knee pain. D'Ambrosi R, Meena A, Raj A, Ursino N, Formica M, Herbort M, Fink C. Knee Surg Sports Traumatol Arthrosc. 0000006682 00000 n 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. 0000007124 00000 n The incision may be longer than the original, however, to allow the old components to be removed. Please enable it to take advantage of the complete set of features! 0000103082 00000 n Extra-articular reconstruction for controlling anterolateral instability is frequently required as well. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The plan to be either be admitted or go home should be discussed with your doctor before your surgery. International Perspective on Revision Anterior Cruciate Ligament Reconstruction: What Have We Been Missing? Tunnel widening is generally cavitary, frequently maximal 0000006046 00000 n You may need some help at home for several days to several weeks after discharge. doi: 10.1016/j.eats.2022.05.014. The indications for two-stage surgery were as follows: (1) the enlargement of Your doctor will examine the soft tissues in your knee to make sure that they are free from infection. 0000103797 00000 n Coders reporting ACL revisions encounter the same limitations as they do for reconstructions essentially one code to describe any arthroscopic ACL procedure. Price: $7,931 CPT Code: 29888 Anterior cruciate ligament reconstruction ( ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate Expected immediate post-operative ACL tunnel diameter should be around 10 mm regardless of graft selection. 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. 0000102737 00000 n 0000102999 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. PMC 0000003452 00000 n In some cases, tiny particles that wear off the plastic spacer accumulate around the joint and are attacked by the body's immune system. 0000007280 00000 n 0000003987 00000 n In some cases, only one implant or component of the prosthesis has to be revised. doi: 10.1016/j.eats.2020.08.024. Orthop J Sports Med. 0000018696 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.