Ccgerson
Guest
I would appreciate any input for the following procedure:
LEFT shoulder arthroscopic superior capsular reconstruction, subscapularis repair, massive debridement subacromial and subcorocoid spaces, acromioplasty and corocoplasty
29806 does not seem appropriate, as that is only for a capsular repair.
29823 and 29826 for debridement and subacromial decompression. But I'm not sure about the capsular reconstruction and subscapularis repair. This was a 4 hour surgery.
Here's a portion of the OP note that describes just the capsular reconstruction:
placed two 3-0 double loaded suture tacks in the anterior and posterior glenoid. I measured the distance at 20 mm. I then placed 2 fiber tape loaded SwiveLocks on the articular margin and I was able to bypass the previously-placed anchors. I measured the anterior-posterior distance here at 15 mm, the medial lateral distance was 25 to both anchors. On the back table I then prepared an ArthroFlex graft and measured and cut it to the appropriate length leaving a 5 mm cuff surrounding with 1 cm on the lateral edge. I punched holes for later passage of the graft. I then retrieved all the sutures and marked them appropriately leaving 1 set of the double loaded in place to act as a passing suture. I then passed these through the graft using a loop from a SwiveLock. I then passed 1 limb of the remaining suture through the graft with a scorpion and tied a mulberry knot. As I was attempting to dock the graft the anterior SwiveLock pulled out. I removed all the sutures and I salvaged the hole by placing a 4.75 mm double loaded SwiveLock into the previous anchor hole. I then passed these sutures in a similar fashion as before. I then removed the passport and was able to dock the graft. The passing sutures were tied in a simple fashion and the remaining sutures were tied as a horizontal mattress using double pulley technique. I then retrieved the retention sutures from the SwiveLock and tied a double pulley on the medial row on the greater tuberosity. I then retrieved 1 limb of the fiber tape from the anterior and posterior and brought them through 2 separate swivel locks creating a speed bridge construct linked to the lateral greater tuberosity. Once this was complete, I passed the retention suture from the subscapularis anchor into the graft and tied this reducing the front edge of the graft to the greater tuberosity. I then passed 2 side-to-side sutures from the infraspinatus into the graft and tied these into place.
Thanks,
Cindy
LEFT shoulder arthroscopic superior capsular reconstruction, subscapularis repair, massive debridement subacromial and subcorocoid spaces, acromioplasty and corocoplasty
29806 does not seem appropriate, as that is only for a capsular repair.
29823 and 29826 for debridement and subacromial decompression. But I'm not sure about the capsular reconstruction and subscapularis repair. This was a 4 hour surgery.
Here's a portion of the OP note that describes just the capsular reconstruction:
placed two 3-0 double loaded suture tacks in the anterior and posterior glenoid. I measured the distance at 20 mm. I then placed 2 fiber tape loaded SwiveLocks on the articular margin and I was able to bypass the previously-placed anchors. I measured the anterior-posterior distance here at 15 mm, the medial lateral distance was 25 to both anchors. On the back table I then prepared an ArthroFlex graft and measured and cut it to the appropriate length leaving a 5 mm cuff surrounding with 1 cm on the lateral edge. I punched holes for later passage of the graft. I then retrieved all the sutures and marked them appropriately leaving 1 set of the double loaded in place to act as a passing suture. I then passed these through the graft using a loop from a SwiveLock. I then passed 1 limb of the remaining suture through the graft with a scorpion and tied a mulberry knot. As I was attempting to dock the graft the anterior SwiveLock pulled out. I removed all the sutures and I salvaged the hole by placing a 4.75 mm double loaded SwiveLock into the previous anchor hole. I then passed these sutures in a similar fashion as before. I then removed the passport and was able to dock the graft. The passing sutures were tied in a simple fashion and the remaining sutures were tied as a horizontal mattress using double pulley technique. I then retrieved the retention sutures from the SwiveLock and tied a double pulley on the medial row on the greater tuberosity. I then retrieved 1 limb of the fiber tape from the anterior and posterior and brought them through 2 separate swivel locks creating a speed bridge construct linked to the lateral greater tuberosity. Once this was complete, I passed the retention suture from the subscapularis anchor into the graft and tied this reducing the front edge of the graft to the greater tuberosity. I then passed 2 side-to-side sutures from the infraspinatus into the graft and tied these into place.
Thanks,
Cindy
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