RebeccaWoodward*
True Blue
I could use some opinions on this one. Thanks!
The arthroscope was introduced through a standard posterior portal and an anterior portal was created as well. The glenohumeral joint was then scanned with the following findings: There was a type I SLAP tear with some bicipital fraying. Teh bicipital anchor was probed and it appeared to be stable with articular cartilage extending over the top of the glenoid. I did not get a sense that this was torn. Subscapularis was intact. The biceps tendon had some fraying just above the labral attachment but the rest of the biceps tendon looked fien as was well centered in the bicipital groove. Glenohumeral articular cartilage was pristine. The anterior labrum appeared to be intact. There was a partial thickness tear of the anterior portion of the rotator cuff in the area defined by the MRI scan.
After debriding the type SLAP tear, the bicipital fraying and the articular sided rotator cuff tear with electrocautery and shaver, I then placed a marking suture through the cuff and brought this out through the anterior portal. The anterior portal and teh arthroscope was then reintroduced in the subacromial space and a standard lateral portal was created. Using these 3 portals, subacromial decompression was performed using standard technique with partial acromioplasty. Distal clavicle resection was not performed since the patient had no AC joint tenderness preoperatively. The marking suture was then visualized in the bursal side and the area of the cuff that it went into was probed and found to be quite weak, and I was able to punch through the cuff at this point. I therefore felt that the rotator cuff tear needed to be completed which I did using electrocautery after removing the marking suture. The edges were then shaved with a shaver and the acromionizer was used to create a bleeding bony bed in the area of the planned rotator cuff repair. Using the Opus System a single #2 fiberwire was placed in mattress fashion. Then this was affixed to the Opus anchor using standard technique. Following completion of the repair, it was tested and found to be quite tight. The rest of the rotator cuff was then inspected and I could see no other significant tearing on the articular side. It was my opinion at this time that the subacromial decompression was also adequate.
Codes provided were 29822, 29807, 29826, 29827
The arthroscope was introduced through a standard posterior portal and an anterior portal was created as well. The glenohumeral joint was then scanned with the following findings: There was a type I SLAP tear with some bicipital fraying. Teh bicipital anchor was probed and it appeared to be stable with articular cartilage extending over the top of the glenoid. I did not get a sense that this was torn. Subscapularis was intact. The biceps tendon had some fraying just above the labral attachment but the rest of the biceps tendon looked fien as was well centered in the bicipital groove. Glenohumeral articular cartilage was pristine. The anterior labrum appeared to be intact. There was a partial thickness tear of the anterior portion of the rotator cuff in the area defined by the MRI scan.
After debriding the type SLAP tear, the bicipital fraying and the articular sided rotator cuff tear with electrocautery and shaver, I then placed a marking suture through the cuff and brought this out through the anterior portal. The anterior portal and teh arthroscope was then reintroduced in the subacromial space and a standard lateral portal was created. Using these 3 portals, subacromial decompression was performed using standard technique with partial acromioplasty. Distal clavicle resection was not performed since the patient had no AC joint tenderness preoperatively. The marking suture was then visualized in the bursal side and the area of the cuff that it went into was probed and found to be quite weak, and I was able to punch through the cuff at this point. I therefore felt that the rotator cuff tear needed to be completed which I did using electrocautery after removing the marking suture. The edges were then shaved with a shaver and the acromionizer was used to create a bleeding bony bed in the area of the planned rotator cuff repair. Using the Opus System a single #2 fiberwire was placed in mattress fashion. Then this was affixed to the Opus anchor using standard technique. Following completion of the repair, it was tested and found to be quite tight. The rest of the rotator cuff was then inspected and I could see no other significant tearing on the articular side. It was my opinion at this time that the subacromial decompression was also adequate.
Codes provided were 29822, 29807, 29826, 29827
