Miko24
Guru
Repair of posterior tibial tendon - CPT 27659
Through meticulous dissection the incision was continued down to the level of the posterior tibial tendon.
With use of a #15 blade the posterior tibial tendon sheath was then incised. At this time a significant amount of
degeneration was noted with scarring of the distal aspect of the tendon from the level of the medial malleolus
to the insertion at the navicular tuberosity. With use of blunt dissection and a tenotomy scissor the tendinous
fibers were carefully dissected and isolated.
Dissection was then continued superiorly where the opposing end of the posterior tibial tendon was then
identified. The scarred ends were then further debrided with a #15 blade to healthy tissue. With use of a #15
blade the insertion of the posterior tibial tendon was then reflected from the anterior dorsal aspect of the
navicular tuberosity leaving the plantar attachments intact. The area was then irrigated with copious amounts of
sterile normal saline. With the use of the Arthrex 3.0 suture tack anchors were then placed ×1 into the
navicular and with use of a modified Kraków technique was then used to securely reattach the posterior tibial
tendon as well as repair the rupture at the level of the medial malleolus creating 1 linear repair.
Medial deltoid ligament repair - CPT 27659
The medial deltoid ligament was appreciated to be significantly atrophied and incompetent. The deltoid
ligament was then incised and reefed to remove a significant amount of non-viable and thinning of the
ligament. A pants over vest technique was then used to imbricate the medial deltoid ligament with 3-0 vicryl.
Fluoroscopy was then used noting significant stability of the medial ankle.
Through meticulous dissection the incision was continued down to the level of the posterior tibial tendon.
With use of a #15 blade the posterior tibial tendon sheath was then incised. At this time a significant amount of
degeneration was noted with scarring of the distal aspect of the tendon from the level of the medial malleolus
to the insertion at the navicular tuberosity. With use of blunt dissection and a tenotomy scissor the tendinous
fibers were carefully dissected and isolated.
Dissection was then continued superiorly where the opposing end of the posterior tibial tendon was then
identified. The scarred ends were then further debrided with a #15 blade to healthy tissue. With use of a #15
blade the insertion of the posterior tibial tendon was then reflected from the anterior dorsal aspect of the
navicular tuberosity leaving the plantar attachments intact. The area was then irrigated with copious amounts of
sterile normal saline. With the use of the Arthrex 3.0 suture tack anchors were then placed ×1 into the
navicular and with use of a modified Kraków technique was then used to securely reattach the posterior tibial
tendon as well as repair the rupture at the level of the medial malleolus creating 1 linear repair.
Medial deltoid ligament repair - CPT 27659
The medial deltoid ligament was appreciated to be significantly atrophied and incompetent. The deltoid
ligament was then incised and reefed to remove a significant amount of non-viable and thinning of the
ligament. A pants over vest technique was then used to imbricate the medial deltoid ligament with 3-0 vicryl.
Fluoroscopy was then used noting significant stability of the medial ankle.
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