AR2728
Expert
OP note attached for quadriceps calcium excision and repair. -Is this quad repair 27430 ??
The right lower extremity was then prepped and draped in a sterile manner. Esmarch bandage was used to exsanguinate the right lower extremity. The tourniquet was
inflated to 300 mm. Hg. The Esmarch was then removed. A midline incision was made proximal to the patella, approximately 1 ½ to 2 inches extending distally. Soft tissue was dissected down until the quadriceps tendon was viewed. Under fluoroscopy the calcium was viewed. An incision was made in the quadriceps tendon. The calcium which was imbedded in the quadriceps tendon was removed as well as the disease quadriceps tendon. Fluoroscopy was viewed and showed significant removal of the calcium. There was calcium which had fused with the patella which was quite significant. As much of this was removed as could be without creating any stress fractures in the patella. At this point in time a 4.5 mm. Arthrex bio-corkscrew was placed in the proximal aspect of the patella. Sutures were then brought out medially and laterally on either size of the quadriceps tendon. #2 fiber wire was placed horizontally through the quadriceps tendon pulling
each end together. These were then tied off. The sutures from the suture anchor were then tied pulling the quadriceps down to the patella. At this point in time the quadriceps was injected with Marcaine as well as the soft tissue surrounding the incision with approximately 30 cc. ¼% Marcaine. The wounds had be closed and irrigated with normal saline. The tourniquet was let down. There is no copious bleeding. 0 vicryl suture was used to close fat and soft tissue. These were deep sutures. 2-0 vicryl suture was used to close subcutaneous. 3-0 monocryl was used to close the skin in a subcuticular manner.
Any suggestions are much appreciated.
April
The right lower extremity was then prepped and draped in a sterile manner. Esmarch bandage was used to exsanguinate the right lower extremity. The tourniquet was
inflated to 300 mm. Hg. The Esmarch was then removed. A midline incision was made proximal to the patella, approximately 1 ½ to 2 inches extending distally. Soft tissue was dissected down until the quadriceps tendon was viewed. Under fluoroscopy the calcium was viewed. An incision was made in the quadriceps tendon. The calcium which was imbedded in the quadriceps tendon was removed as well as the disease quadriceps tendon. Fluoroscopy was viewed and showed significant removal of the calcium. There was calcium which had fused with the patella which was quite significant. As much of this was removed as could be without creating any stress fractures in the patella. At this point in time a 4.5 mm. Arthrex bio-corkscrew was placed in the proximal aspect of the patella. Sutures were then brought out medially and laterally on either size of the quadriceps tendon. #2 fiber wire was placed horizontally through the quadriceps tendon pulling
each end together. These were then tied off. The sutures from the suture anchor were then tied pulling the quadriceps down to the patella. At this point in time the quadriceps was injected with Marcaine as well as the soft tissue surrounding the incision with approximately 30 cc. ¼% Marcaine. The wounds had be closed and irrigated with normal saline. The tourniquet was let down. There is no copious bleeding. 0 vicryl suture was used to close fat and soft tissue. These were deep sutures. 2-0 vicryl suture was used to close subcutaneous. 3-0 monocryl was used to close the skin in a subcuticular manner.
Any suggestions are much appreciated.
April