# Arthroscipic patelloplasty



## martnel (Oct 5, 2009)

This sounds a lot like a chondroplasty 29877 to me, or should I rather use the unlisted code 29999?

NAME OF OPERATION:	arthroscopic patellaplasty, left knee.

INDICATIONS FOR PROCEDURE:  This is a gentleman with history of patella fracture and patellofemoral arthritis.  He has tried conservative measures but has not responded.  He was not interested in a total knee replacement and the option of a patellaplasty to remove the overhanging lateral osteophyte of the patella was discussed.  

PROCEDURE IN DETAIL:   
At this point, a standard anterolateral arthroscopic portal was established. A spinal needle was used to locate an anteromedial portal.  Inspection of the joint confirmed severe patellofemoral arthritis with osteophytes.  Medially, his joint space was maintained.  He had no meniscal tears in the notch.  He appeared to have only a remnant of the anterior cruciate ligament.  It was very thin and did not appear to be fully functional.  He had a very large osteophyte over the medial tibial spine.  This was resected using the arthroscopic burr.  Inspection of the lateral joint revealed that he did have some grade IV chondromalacia of the lateral femoral condyle.  There was an anterior horn meniscal tear which was lightly debrided using the arthroscopic shaver.  There was no obvious unstable area that needed further treatment.

At this point, further inspection of the patellofemoral joint revealed a large inferomedial osteophyte over the patella that was impairing our visualization.  This was trimmed with an arthroscopic burr as was an overhanging medial femoral osteophyte off of the trochlea.  At this point, a mid lateral and then a superolateral portal were established for further access to the patellofemoral compartment.  The arthroscopic burr was used to shave approximately 10 to 12 mm of overhanging osteophyte off the patella and to a lesser extent off the femoral condyle at the level of the trochlea laterally.  Care was taken not to penetrate the overlying retinaculum.  Following this, the remainder of the joint fluid was expressed.  The lateral arthroscopic portals were closed with a subcutaneous stitch of 2-0 Vicryl.  The skin was closed with a 3-0 nylon in simple fashion.  A sterile dressing was applied with Adaptic, 4 x 4s, and ABD pads.  Two folded ABD pads were used as a bolster over the area where the patella osteophyte was removed to prevent excessive swelling in this region.  An Ace wrap was applied with medium compression from the foot to the thigh.  The patient was placed in a knee immobilizer.  He was transported to the recovery room in stable condition.


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## coderguy1939 (Oct 5, 2009)

Sounds like chondroplasty to me, too.


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## nyyankees (Oct 6, 2009)

What about 29881 (menisectomy)? There was a tear that was "lightly debrided with a shaver". Anyone else agree?


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## martnel (Oct 6, 2009)

Yes to add 29881 for debridement of anterior horn meniscus tear. Do you agree with 29877 also?   Thanks for your input, also to coderguy!


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