JULY 2013 MD Strategies
Medial Patellofemoral Ligament Reconstruction
The following is an example of an operative report describing a medial patellofemoral ligament reconstruction.
PROCEDURE PERFORMED:
Open medial patellofemoral ligament reconstruction with semitendinosus allograft.
The patient was taken to the operating suite and placed in the supine position on the operating table where general anesthesia was administered. The knee was examined. The 4 ligaments to the knee were normal. The knee had good motion. There was lateral patellar subluxation with range of motion. There was marked laxity of the medial retinaculum and medial restraints with fourth quadrant lateral subluxation of the patella with applied translation. At this time, her leg was prepped and draped in the usual sterile fashion. The previous medial patellar incision was re-incised. It was lengthened a bit inferiorly and superiorly. Dissection carried down through the skin and subcutaneous tissues.
The medial retinaculum along the medial patellar border was incised to expose the medial border of the patella. Previous sutures were seen. Dissection was then carried down between the vastus medialis obliquus in the underlying femur to create a tunnel for the position of the medial patellofemoral ligament. Along the posterior aspect of the vastus medialis obliquus, the femur was exposed. We could see the adductor tubercle and the medial femoral epicondyle with the depression in between the two for positioning of the femoral attachment of the medial patellofemoral ligament. At this point, a guidepin was placed drilling from posterior to anterior and from inferior to superior traversing the femur and exiting percutaneously along the lateral side of the femur. The looped end of the semitendinosus allograft, which was prepared by the physician's assistant, was 7.5 mm, therefore, 7.5 mm tunnel was created in the femur. The total distance of the tunnel was 40 mm. The femoral tunnel was completed with the EndoButton drill to exit femoral cortex. Total length of the tunnel and EndoButton hole was 70 mm. At this point, the 2 drill holes were created on the patella, 1 drill hole more superiorly was created from medial to lateral. It was about 7 mm distal to the superior patellar pole. A 5 mm drill was used. It was drilled 20 mm across the patella from medial to lateral. A second 5 mm tunnel also 20 mm in length was created about a centimeter distal to the first tunnel but still superior to the mid portion of the patella. Next, the looped end of the graft was passed into the femoral tunnel with the attached TightRope and button device. The button was flipped and deployed along the lateral femoral cortex. The looped end of the graft was then advanced up into the femoral socket. Next, the 2 free ends of the graft were passed beneath the vastus medialis obliquus and then brought up to the medial border of the patella. The free end of each graft was brought into the corresponding patellar drill hole. The sutures on the free end of the graft were then ligated over the lateral patellar border tensioning the medial patellofemoral ligament.
Based on information from the AMA this procedure would be reported as 27422 - Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release.