Hi list I am getting the 27415 but would you also add on 29877?
TIA
M,CCS,CPC
PREOPERATIVE DIAGNOSIS:
Chondral defect/failed BioCartilage, left medial femoral
condyle.
POSTOPERATIVE DIAGNOSIS:
Chondral defect/failed BioCartilage, left medial femoral
condyle.
PROCEDURES:
1. Open osteochondral allograft implantation, left medial
femoral condyle (27415).
2. Diagnostic arthroscopy, left knee (29870).
SURGEON:
ASSISTANT:
.
ANESTHESIA:
General.
ESTIMATED BLOOD LOSS:
150 mL.
INTRAVENOUS FLUIDS:
See anesthesia record.
INDICATIONS FOR PROCEDURE:
The patient is a 43-year-old male who underwent BioCartilage
treatment for his left medial femoral condyle lesion on May 6,
2014. He continued to have pain and dysfunction to the point
where a postoperative MRI revealed incomplete healing
subchondral bone edema. He was advised the risks and benefits
of revision, osteochondral allograft implantation. He
understood those risks and benefits and agreed to proceed with
surgery today.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room, placed supine
on the OR table, underwent general anesthesia without
difficulty. Preop time-out was done, identifying his left
knee as the operative knee. He was given preoperative
antibiotics and a block in the holding area. He was placed in
a sterile tourniquet and examination under anesthesia revealed
a stable Lachman, stable to varus and valgus stress, stable
anterior and posterior drawer. He was placed in a leg holder
with all bony prominences padded, prepped and draped in
sterile fashion using ChloraPrep. His limb was elevated,
exsanguinated and tourniquet was raised. Standard diagnostic
arthroscopy was performed using anteromedial and anterolateral
portal with the following findings. He had grade II
chondromalacia on the back of his patella, grade II
chondromalacia on his trochlea that was debrided back to
stable rim using oscillating shaver. There was a soft tissue
cyst in his intercondylar notch similar to a cyclops lesion
that was resected with the arthroscopic shaver]. His medial
femoral condyle did have intact fibrocartilage along the
entire 2.5 x 1.5 cm medial femoral condyle lesion; however,
there was no attachment with the fibrocartilage to bone.
There was a large cleft at the mid aspect of the lesion and
the lesion was unstable to palpation with the probe. We
therefore debrided and used a curette to remove the
fibrocartilage back to the stable bony rim. Intercondylar
notch revealed intact ACL and PCL. Lateral joint revealed an
intact lateral meniscus. No chondromalacia.
We then turned our attention to the open part of the
procedure, his medial portal was extended generously to a
medial parapatellar arthrotomy. We then had good access to
lesion. We used the curette to further prepare the lesion
down to bleeding bone. We used the Arthrex allograft Oats
system in order to size the lesion appropriately. It was an
ovoid lesion that would not be amenable to a single plug. We
therefore elected two 15 mm plugs. We sequentially measured
and then drilled the recipient site, first being careful to
dilate and mark the 12 o'clock region for the snowman plugs.
We then turned our attention to the backtable where the
allograft was carefully marked and drilled appropriately. The
grafts were contoured appropriately to fit the recipient
sites. They were both fit in a press-fit manner and then
subsequently fixed with one Bio-Absorbable 20 mm Arthrex
screw. They sat flush with the articular surface,
particularly on the weightbearing side. There was no
dislodgement with the range of motion, they were nice and
stable. We then copiously irrigated the wound and closed the
arthrotomy using interrupted #2 Vicryl stitches in a
figure-of-eight fashion. 2-0 Vicryl was used on subcutaneous
layer and then 3-0 nylon in a horizontal mattress fashion used
on the skin. Xeroform, dressing sponges, Webril, ABD and Ace
wrap were applied. We also placed the patient in a hinged
knee brace from 0-90 degrees. He tolerated the procedure well
and transferred to recovery room in stable condition.
Postoperatively, he will be touchdown weightbearing for a
total of 6 weeks. We will start him on physical therapy in
1-3 days on my microfracture and allograft Oats rehab
protocol. He will also need a CPM for a total of 4-6 weeks
for passive range of motion.
TIA
M,CCS,CPC
PREOPERATIVE DIAGNOSIS:
Chondral defect/failed BioCartilage, left medial femoral
condyle.
POSTOPERATIVE DIAGNOSIS:
Chondral defect/failed BioCartilage, left medial femoral
condyle.
PROCEDURES:
1. Open osteochondral allograft implantation, left medial
femoral condyle (27415).
2. Diagnostic arthroscopy, left knee (29870).
SURGEON:
ASSISTANT:
.
ANESTHESIA:
General.
ESTIMATED BLOOD LOSS:
150 mL.
INTRAVENOUS FLUIDS:
See anesthesia record.
INDICATIONS FOR PROCEDURE:
The patient is a 43-year-old male who underwent BioCartilage
treatment for his left medial femoral condyle lesion on May 6,
2014. He continued to have pain and dysfunction to the point
where a postoperative MRI revealed incomplete healing
subchondral bone edema. He was advised the risks and benefits
of revision, osteochondral allograft implantation. He
understood those risks and benefits and agreed to proceed with
surgery today.
DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room, placed supine
on the OR table, underwent general anesthesia without
difficulty. Preop time-out was done, identifying his left
knee as the operative knee. He was given preoperative
antibiotics and a block in the holding area. He was placed in
a sterile tourniquet and examination under anesthesia revealed
a stable Lachman, stable to varus and valgus stress, stable
anterior and posterior drawer. He was placed in a leg holder
with all bony prominences padded, prepped and draped in
sterile fashion using ChloraPrep. His limb was elevated,
exsanguinated and tourniquet was raised. Standard diagnostic
arthroscopy was performed using anteromedial and anterolateral
portal with the following findings. He had grade II
chondromalacia on the back of his patella, grade II
chondromalacia on his trochlea that was debrided back to
stable rim using oscillating shaver. There was a soft tissue
cyst in his intercondylar notch similar to a cyclops lesion
that was resected with the arthroscopic shaver]. His medial
femoral condyle did have intact fibrocartilage along the
entire 2.5 x 1.5 cm medial femoral condyle lesion; however,
there was no attachment with the fibrocartilage to bone.
There was a large cleft at the mid aspect of the lesion and
the lesion was unstable to palpation with the probe. We
therefore debrided and used a curette to remove the
fibrocartilage back to the stable bony rim. Intercondylar
notch revealed intact ACL and PCL. Lateral joint revealed an
intact lateral meniscus. No chondromalacia.
We then turned our attention to the open part of the
procedure, his medial portal was extended generously to a
medial parapatellar arthrotomy. We then had good access to
lesion. We used the curette to further prepare the lesion
down to bleeding bone. We used the Arthrex allograft Oats
system in order to size the lesion appropriately. It was an
ovoid lesion that would not be amenable to a single plug. We
therefore elected two 15 mm plugs. We sequentially measured
and then drilled the recipient site, first being careful to
dilate and mark the 12 o'clock region for the snowman plugs.
We then turned our attention to the backtable where the
allograft was carefully marked and drilled appropriately. The
grafts were contoured appropriately to fit the recipient
sites. They were both fit in a press-fit manner and then
subsequently fixed with one Bio-Absorbable 20 mm Arthrex
screw. They sat flush with the articular surface,
particularly on the weightbearing side. There was no
dislodgement with the range of motion, they were nice and
stable. We then copiously irrigated the wound and closed the
arthrotomy using interrupted #2 Vicryl stitches in a
figure-of-eight fashion. 2-0 Vicryl was used on subcutaneous
layer and then 3-0 nylon in a horizontal mattress fashion used
on the skin. Xeroform, dressing sponges, Webril, ABD and Ace
wrap were applied. We also placed the patient in a hinged
knee brace from 0-90 degrees. He tolerated the procedure well
and transferred to recovery room in stable condition.
Postoperatively, he will be touchdown weightbearing for a
total of 6 weeks. We will start him on physical therapy in
1-3 days on my microfracture and allograft Oats rehab
protocol. He will also need a CPM for a total of 4-6 weeks
for passive range of motion.