nsteinhauser
Expert
I'm stumped and need help. Open excision loose bodies from the quad tendon and also debridement of osteophytic ridge on the patella with anchors used afterwards to fix the tendon to the patella .......op note below:
Based on review of MRI scan, vertical incision was made along the junction of the mid and lateral pole, then dissection carried down through to the superficial surface of the extensor mechanism. On palpation of the superior pole of the patella, a mobile osseous density could be readily palpated. Longitudinal split in the tendon was performed directly over this area, and an ovoid osseous body separate from the patella was then shelled from the surrounding deep portion of the quadriceps tendon and fat pad. Bony density approximately 1 cm x 0.5 cm was removed. On palpation of tissue adjacent to this, there was found to be another relatively large osseous body slightly lateral. This also was shelled out. At this point, significant calcifications were noted throughout the substance of the deep portion of the quadriceps at the superior pole of the patella. That tissue was debrided with sharp dissection and a rongeur. Remaining osteophytic ridge on the superior patella was then debrided with a rongeur and rasp. Wound was irrigated and the areas of tendon adjacent to the osseous bodies that were excised were then repaired directly to the superior pole of the patella. This was performed using two 1.9 mm SutureFix anchors with the suture passed through the tendon to secure the insertion. The longitudinal split was closed with interrupted 0 Vicryl suture followed by buried and running 3-0 Biosyn subcuticular stitch, Steri-Strips and a gauze dressing. The patient was then placed in a knee immobilizer.
I looked at 27331 but the lay description says exploration of the joint and he never entered the joint itself. 20525 is removal of a fb from muscle, deep. Do osseous loose bodies count as FOREIGN BODIES? 27350 is patellectomy or hemipatellectomy but is that appropriate with debridement of an osteophytic ridge? Seems a little much. And then the fixation afterwards = 27380? But that lay description sounds more involved than anchoring it back onto the patella.
Any and all suggestions would be much appreciated. Thank you!!!!
Based on review of MRI scan, vertical incision was made along the junction of the mid and lateral pole, then dissection carried down through to the superficial surface of the extensor mechanism. On palpation of the superior pole of the patella, a mobile osseous density could be readily palpated. Longitudinal split in the tendon was performed directly over this area, and an ovoid osseous body separate from the patella was then shelled from the surrounding deep portion of the quadriceps tendon and fat pad. Bony density approximately 1 cm x 0.5 cm was removed. On palpation of tissue adjacent to this, there was found to be another relatively large osseous body slightly lateral. This also was shelled out. At this point, significant calcifications were noted throughout the substance of the deep portion of the quadriceps at the superior pole of the patella. That tissue was debrided with sharp dissection and a rongeur. Remaining osteophytic ridge on the superior patella was then debrided with a rongeur and rasp. Wound was irrigated and the areas of tendon adjacent to the osseous bodies that were excised were then repaired directly to the superior pole of the patella. This was performed using two 1.9 mm SutureFix anchors with the suture passed through the tendon to secure the insertion. The longitudinal split was closed with interrupted 0 Vicryl suture followed by buried and running 3-0 Biosyn subcuticular stitch, Steri-Strips and a gauze dressing. The patient was then placed in a knee immobilizer.
I looked at 27331 but the lay description says exploration of the joint and he never entered the joint itself. 20525 is removal of a fb from muscle, deep. Do osseous loose bodies count as FOREIGN BODIES? 27350 is patellectomy or hemipatellectomy but is that appropriate with debridement of an osteophytic ridge? Seems a little much. And then the fixation afterwards = 27380? But that lay description sounds more involved than anchoring it back onto the patella.
Any and all suggestions would be much appreciated. Thank you!!!!
