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. The .gov means its official. 2022 Aug 20;56(10):1703-1716. doi: 10.1007/s43465-022-00719-z. eCollection 2021 Jan. Abdel-Aziz A, Waly MR, Abdel-Aziz MA, Sherif MM, Elhaddad H, Mostafa Zaky Abdelrazek BH. These fractures are most often the result of a fall, and usually require revision surgery. Your healthcare team can also help you arrange for a short stay in an extended care facility during your recovery, if needed. Clipboard, Search History, and several other advanced features are temporarily unavailable. 0000102737 00000 n Before To break up scar tissue, your doctor may perform manipulation under anesthesia. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). In this procedure, your doctor removes some or all of the parts of the original prosthesis and replaces them with new ones. An emerging procedure, thermal ACL shrinkage, is used to stretch injuries of the ligament that do not require tendon graft. Web1. 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. 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. The incision may be longer than the original, however, to allow the old components to be removed. 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. He or she may also aspirate your knee. In some cases, tiny particles that wear off the plastic spacer accumulate around the joint and are attacked by the body's immune system. American Hospital Association ("AHA"), Posterolateral Corner Reconstruction Knee. 2021 Oct 12;11(4):e20.00055. This percentage will help the payer to determine what extra percentage of the normal fee to reimburse for the extra work. 2020 Dec 21;9(12):e1917-e1925. If your knee replacement fails, your doctor may recommend that you have a second surgeryrevision total knee replacement. 0000075493 00000 n 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. You will either be admitted to the hospital on the day of surgery or you will go home the same day. The implant may begin to lose its attachment to the bone. This is needed to make sure that you are healthy enough to have the surgery and complete the recovery process. Conflict of interestSachin Tapasvi and Anshu Shekhar declare that they have no conflict of interest. Register Online, Autograft anterior cruciate ligament reconstruction (including arthroscopic and meniscectomy), Excision of lesion of peripheral nerve (e.g. 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. 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. sharing sensitive information, make sure youre on a federal ACL reconstruction revision; Bone healing; Bone mineral density; Iliac bone grafting; Two-staged ACL reconstruction revision. 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. 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. PDF | Revision anterior cruciate ligament (ACL) reconstruction is substantially more challenging than primary reconstruction. Keywords: 0000004216 00000 n The surgeon should explain the specific complications he or she encountered (removal of graft material distant graft site etc.) If knee instability cannot be treated through nonsurgical means such as bracing and physical therapy, revision surgery may be needed. Price: $7,931 CPT Code: 29888 Anterior cruciate ligament reconstruction ( ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate 0000076075 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. 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. If you are admitted to the hospital, you may stay for several days. 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. 0000020747 00000 n If extensive scar tissue or the position of the components in your knee is limiting your range of motion, revision surgery may be needed. 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. Two-Stage Revision Anterior Cruciate Ligament Reconstruction. Your doctor will talk with you about which option is best for you. You will have stitches or staples running along your wound or a suture beneath your skin on the front of your knee. 0000009431 00000 n 0000013979 00000 n 0000004674 00000 n Erickson BJ, Cvetanovich G, Waliullah K, Khair M, Smith P, Bach B Jr, Sherman S. Orthopedics. Your doctor may prescribe one or more measures to prevent blood clots and decrease leg swelling. 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. 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. Clipboard, Search History, and several other advanced features are temporarily unavailable. With two exceptions HCPCS code G0289 (Surgical knee arthroscopy for removal of loose body, foreign body, debridement/shaving of articular cartilage at the time Ziegler CG, DePhillipo NN, Kennedy MI, Dekker TJ, Dornan GJ, LaPrade RF. Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. 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. Revision ACL reconstruction can be performed in one or two stages. %%EOF 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. Epub 2022 Sep 7. 0000034378 00000 n You may need some help at home for several days to several weeks after discharge. Over time, however, a knee replacement may fail for a variety of reasons. 0000003488 00000 n I think 27558 more appropriate. If an artificial joint becomes infected, it may become stiff and painful. 2017 Feb 15;66:543-556. 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. 0000005887 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. 0000076243 00000 n 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). presence of scar tissue complicating the surgical dissection. Injured ligaments can make the knee unstable. Removing the implant leads to a higher chance of curing the infection, but is associated with a longer recovery. Preventing Blood Clots After Orthopaedic Surgery, Preventing Infection After Joint Replacement Surgery. 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. Doing so indicates to the payer that extra work was performed above and beyond the normal scope of the procedure. 0000006762 00000 n WebTwo-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review of Bone Graft Options for Tunnel Augmentation 2020 Mar;48 (3):767-777. doi: In most cases, this procedure is successful in improving range of motion. In osteolysis, the bone around the implant deteriorates, making the implant loose or unstable. <<0442EB843D58CB429143788B7DE0A388>]/Prev 973684>> Combat the #1 denial reason - mismatched CPT-ICD-9 codes - with top Medicare carrier and private payer accepted diagnoses for the chosen CPT code. PMC 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. 0000006441 00000 n 0000006521 00000 n Functional results of multiple revision anterior cruciate ligament with anterolateral tibial tunnel associated with anterolateral ligament reconstruction. 0000003323 00000 n The https:// ensures that you are connecting to the Federal government websites often end in .gov or .mil. Arthroscopy. Once the incision is made, the doctor will move the kneecap and tendons to the side to reveal your knee joint. 0000006602 00000 n "This is an obvious frustration to surgeons and coders " she adds "because the range of work in a repair versus a reconstruction is wide." Advances in material science and plastic quality have made osteolysis less common today than in past decades. Imaging tests. Multiple revision anterior cruciate ligament reconstruction: not the best but still good. Unable to load your collection due to an error, Unable to load your delegates due to an error. While the ligament is a good starting point, you must also take into consideration the type of repair being performed. This site needs JavaScript to work properly. Infection may occur while you are in the hospital or after you go home. Although the procedure can be done by open repair, it is most often accomplished arthroscopically. 0000018169 00000 n Accessibility " There are several methods by which a physician can achieve anterior cruciate ligament (ACL) revision or reconstruction, but only two codes to describe them. endstream endobj 306 0 obj <>/Outlines 398 0 R/PageLabels<>1<. Disclaimer. 0000004907 00000 n After removing the original implant, your doctor will prepare the bone surfaces for the revision implant. 2021 Jan 29;9(1):2325967120977834. doi: 10.1177/2325967120977834. 20 percent 30 percent) the procedure was as a result of this altered surgical field. This spacer is treated with antibiotics to fight the infection and will remain in your knee for several weeks. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Careers. Donor tendon, or allograft, is used to create the new ACL. WebAim: To quantify healing of tibial bone tunnels after bone grafting in two-stage ACL reconstruction revision. An official website of the United States government. 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. Adams D, Logerstedt D, et al. Hybrid Bone-Grafting Technique for Staged Revision Anterior Cruciate Ligament Reconstruction. Right knee arthroscopy, viewing from the anterolateral portal, knee is 30 flexion and valgus force applied. If the ligaments around your knee become damaged or improperly balanced, your knee may become unstable. 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. Coders reporting ACL revisions encounter the same limitations as they do for reconstructions essentially one code to describe any arthroscopic ACL procedure. View matching HCPCS Level II codes and their definitions. 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 Laboratory tests. The possible risks and complications of revision surgery include: Managing Pain With Medications After Orthopaedic Surgery. All rights reserved. The femur (thighbone) has broken in several places around the implant. eCollection 2022 Oct. Garcia-Mansilla I, Jones KJ, Kremen TJ Jr. JBJS Essent Surg Tech. (The patellar component is not shown here.). 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. 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. The site is secure. Preoperative Planning for ACL Revision Surgery. 0000014223 00000 n Sometimes, however, the knee remains stiff. 0000015728 00000 n 0000009634 00000 n 0000008438 00000 n 2012 Oct;28(10):1464-71. doi: 10.1016/j.arthro.2012.04.053. All material on this website is protected by copyright. Unauthorized use of these marks is strictly prohibited. The majority of patients who have revision surgery experience favorable long-term outcomes, including relief from pain and increased stability and function. 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 Anterior cruciate ligament; Anterior cruciate ligament reconstruction; Autograft; One-stage reconstruction; Posterior tibial slope; Re-tear; Revision; Tunnel dilatation; Tunnel malposition; Two-stage reconstruction. eCollection 2020 Dec. Knee Surg Relat Res. Does anyone know which ligaments are intra-articular & which are extra-articular? Infection has to be ruled out prior to planning any reconstructive surgical procedure. 27427 Which ligamens are intra-articular and which are extra-articular. Before your surgery, arrange for a friend, family member or caregiver to provide help at home. 0000019179 00000 n View any code changes for 2023 as well as historical information on code creation and revision. 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. 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. 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). What to Do If Your Orthopaedic Surgery Is Postponed. One of the most serious complications facing patients who undergo revision surgery is infection. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster. 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. 2021 Jan;37(1):195-205. doi: 10.1016/j.arthro.2020.08.031. Search across Medicare Manuals, Transmittals, and more. National Library of Medicine Limited Coding Options Several codes describe open ACL repair and reconstruction, but with the advent and domination of arthroscopy, the codes are largely obsolete. Sometimes a total knee replacement may not help you achieve the range of motion that is needed to perform everyday activities. (Top): Examples of metal augments that can be added to implants to make up for lost bone. For information:Questions and Answers for Patients Regarding Elective Surgery and COVID-19. Outcomes of revision anterior cruciate ligament reconstruction secondary to reamer-irrigator-aspirator harvested bone grafting. Also, patients who are younger when they undergo the initial knee replacement may "outlive" the life expectancy of their artificial knee. In many areas, nonessential orthopaedic procedures that were postponed due to COVID-19 have resumed. 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. In a 1-stage surgerywhich is less commonly performedthe implant is removed, the joint is washed out, and the new implant is placed during the same surgery. 0000076909 00000 n 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. The average ORs were 81, 85 and 94%, and the average URs were 49, 75 and 89% at three, 12 and 24weeks, respectively. 09/12/2018 00:00:00 to 23/12/2018 00:00:00, This site uses cookies. Because of the already surgically altered operative field ACL revisions are more complex than repairs or reconstructions. Would you like email updates of new search results? government site. 0000023425 00000 n Disclaimer. Your surgeon will use a piece of tendon from another part of your knee or a tendon from a deceased donor. Watch: Preventing Blood Clots After Orthopaedic Surgery. Before your surgery, your doctor will discuss each of the risks with you and will take specific measures to help avoid potential complications. And arthro-scopic ACL repair or reconstruction has only one code: 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction). Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Severe tunnel dilatation, infection, or arthrofibrosis necessitates a two 0000018637 00000 n Unauthorized use of these marks is strictly prohibited. In complex cases, the surgery may take several hours. 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." As the major stabilizing ligament of the knee, it prevents buckling and instability. 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. These may include special graded compression stockings, inflatable leg coverings (compression boots), and blood thinners. During this time, you will also receive intravenous antibiotics. American Hospital Association ("AHA"). 2022 Mar 11;10(3):23259671221083318. doi: 10.1177/23259671221083318. This immune response also attacks the healthy bone around the implant, leading to a condition called osteolysis. 305 0 obj <> endobj I think AAOS was meant, not AAQOS. Welder E, Magnussen RA, Fitzpatrick S, Duerr RA, Kaeding CC, Flanigan DC. trigger finger), Trigger point injection/Enthesis - 1 injection, Major release of muscle for pain or contracture (e.g. Outcomes of Combined Lateral Meniscus Posterior Root Repair and Anterior Cruciate Ligament Reconstruction. 0000032820 00000 n Many types of medicines are available to help manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. 0000076190 00000 n 0000007124 00000 n An official website of the United States government. JOSPT 2012 Medicare and some Please enable it to take advantage of the complete set of features! 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. Osseous malalignment in the coronal or sagittal planes would also need correction along with or prior to revision ACL surgery. Epub 2012 Aug 2. von Recum J, Schwaab J, Guehring T, Grtzner PA, Schnetzke M. Arthroscopy. 0000102850 00000 n It is important to use opioids only as directed by your doctor. 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? The scarcity of codes for the ACL repair reveals the reimbursement challenge. Find out more here. Subscribe to. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. 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 either case, the implant was firmly fixed. Rarely, bone graft material may be used to help rebuild the knee. Extraarticular ligaments are the ligaments located outside the knee joint. 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. Coding for arthroscopic reconstruction of anterior cruciate ligament (ACL) surgery. If cement was used in the primary total knee replacement, this is removed, as well. 0000022162 00000 n Borchers JR, Kaeding CC, Pedroza AD, Huston LJ, Spindler KP, Wright RW; MOON Consortium and the MARS Group. 0000011499 00000 n You may need a walker, cane, or crutches for the first few days or weeks until you are comfortable enough to walk without assistance. 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. Conclusion: 0000103797 00000 n 0000020113 00000 n Accessed May 2015. 0000003987 00000 n To prevent infection, you will be given antibiotics before and, in some cases, after surgery. Revision total knee replacement is more complex and takes longer to perform than primary total knee replacement. The risk of infection is slightly higher after revision surgery than after primary total knee replacement. Both can't be billed. The .gov means its official. When it comes to ACL reconstruction surgery you have two main options, autograft and allograft. Results: 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. Rotator Cuff and Shoulder Conditioning Program. 0000008179 00000 n 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. The doctor then bends your knee in an attempt to break up the scar tissue. 0000103928 00000 n doi: 10.1016/j.eats.2020.08.024. "This is an obvious frustration to surgeons and coders " she adds "because the range of work in a repair versus a reconstruction is wide." If this occurs, your doctor may attempt "manipulation under anesthesia.". Revision ACL reconstruction is a complex undertaking due to limited graft options, compromised anatomy and high frequency of associated injuries. startxref Factors contributing to ACL failure may be classified as patient-related, surgeon-related, and biological factors. This percentage will help the payer to determine what extra percentage of the normal fee to reimburse for the extra work. 0000000016 00000 n To determine whether you have an infection, your doctor may order blood tests. When the tendon is harvested from the patient, harvesting takes place at the same time as the reconstructive surgery.
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