BFAITHFUL
Expert
I know the AAOS states more than just anchors & screws used, & AMA states at least three tendons should be repaired. but I think I will never be confident to distinguish between the two.. what's your opinion on this..
23412 or 23420, I do see doc mentions something about using graft from the supraspinatus tendon.. I bill for ASC so I can't really talk to the doc himself.
52 year old right hand dominant female with status post rotator cuff repair performed on November 11, 2009. She has been progressing physical therapy. however she has approached a point where she began to lose the ability to abduct her arm and repeat MR arthrogram had shown that she had a retear of supraspinatus tendon repair. she is therefore indicated for repair of this tendon.
The previous incision site was marked out and was infiltrated with 1% lidocaine with epinephrine. A #10 blade was used to cut down through this incision to the clavipectoral fascia was obtained. The skin edges were then underminated circumfernetially and the deltoid tendon insertion on to the acromion and clavicle were identified. A bovie electrocautery was used to perform a deltoid on elevation of the deltoid tendon of the acromion and distal clavicle. This was then in a full thickness fashion and the small key elevator uas used to elevate the tissue adherent to the undersurface of the acromion. after the deltoid tendon was incised and retractors were placed. there was noted to be significant thickened hypertrophic bursal tissue, which was removed. The rotator cuff itself did not appear to have significant amount of redundancy consistent with interstitial type of the tear. The subscapularis and infraspinatus tendons were appeared to be intact. The #15 blade was then used to incise to the area of attenuated tissue until viable tissue was again visualized on the edge. a needle nose ronguer was used to create a bony trough in the lateral aspect of the humerus slightly medial to the previous anchor insertion point. the skin was then tensioned and excess tissue was excised with a #15 blade to provide the appropriate amount of tension on the repair was brought down to the cancellous bed on humerus. At this point the drill from the Mitek G4 anchors were used to place three anchors within the bony trough which had been created and graft of the supraspinatus tendon was tensioned and the sutures were placed through this and the arm was abducted and the tendon was brought within the bony trough and the sutures were tied. the sutures were less intact and down to the repair was inspected and found to be intact. There was passed under the cuff of tissue, which was left on lateral aspect of the humerus and these were tied down again to prior additional stability. the arm was taken through a range of motion. There was noted to be appropriate tension on the supraspinatus tendon. The area was copiously irrigated. The undersurfaces of the acromion was palpated and found to be exceedingly smooth with no areas of impingement.
Thank you
23412 or 23420, I do see doc mentions something about using graft from the supraspinatus tendon.. I bill for ASC so I can't really talk to the doc himself.
52 year old right hand dominant female with status post rotator cuff repair performed on November 11, 2009. She has been progressing physical therapy. however she has approached a point where she began to lose the ability to abduct her arm and repeat MR arthrogram had shown that she had a retear of supraspinatus tendon repair. she is therefore indicated for repair of this tendon.
The previous incision site was marked out and was infiltrated with 1% lidocaine with epinephrine. A #10 blade was used to cut down through this incision to the clavipectoral fascia was obtained. The skin edges were then underminated circumfernetially and the deltoid tendon insertion on to the acromion and clavicle were identified. A bovie electrocautery was used to perform a deltoid on elevation of the deltoid tendon of the acromion and distal clavicle. This was then in a full thickness fashion and the small key elevator uas used to elevate the tissue adherent to the undersurface of the acromion. after the deltoid tendon was incised and retractors were placed. there was noted to be significant thickened hypertrophic bursal tissue, which was removed. The rotator cuff itself did not appear to have significant amount of redundancy consistent with interstitial type of the tear. The subscapularis and infraspinatus tendons were appeared to be intact. The #15 blade was then used to incise to the area of attenuated tissue until viable tissue was again visualized on the edge. a needle nose ronguer was used to create a bony trough in the lateral aspect of the humerus slightly medial to the previous anchor insertion point. the skin was then tensioned and excess tissue was excised with a #15 blade to provide the appropriate amount of tension on the repair was brought down to the cancellous bed on humerus. At this point the drill from the Mitek G4 anchors were used to place three anchors within the bony trough which had been created and graft of the supraspinatus tendon was tensioned and the sutures were placed through this and the arm was abducted and the tendon was brought within the bony trough and the sutures were tied. the sutures were less intact and down to the repair was inspected and found to be intact. There was passed under the cuff of tissue, which was left on lateral aspect of the humerus and these were tied down again to prior additional stability. the arm was taken through a range of motion. There was noted to be appropriate tension on the supraspinatus tendon. The area was copiously irrigated. The undersurfaces of the acromion was palpated and found to be exceedingly smooth with no areas of impingement.
Thank you
