Lacybarfield
Contributor
would you code limited debridement for this case?
The right shoulder and upper extremity were then prepped and draped in a standard sterile fashion. The glenohumeral joint was injected with 10 mL of 0.25% Marcaine with epinephrine. A standard posterior portal and anterosuperior portal and straight lateral portals were established and diagnostic arthroscopy was performed. The patient had severe tearing of the intraarticular portion of the long head of the biceps tendon extending into a large devastating type 2 SLAP lesion. The entire circumference of the labrum was horribly torn. There was a small amount of chondromalacia along the anterior, inferior chondral labral junction of the glenoid. There was a full-thickness rotator cuff tear measuring 4 cm in width. The axillary pouch was normal. The middle glenohumeral ligament labral complex and the inferior glenohumeral ligament labral complex was intact. The subscapularis tendon was intact. I proceeded to perform an extensive debridement of the glenohumeral joint using a torpedo shaver. This included extensively debriding the biceps tendon, extensively debriding the SLAP lesion, extensively debriding the rotator cuff tear, extensively debriding the labral tear, performing a chondroplasty in the anterior chondral labral junction of the glenoid and extensively debriding the synovitis within the glenohumeral joint using a torpedo shaver and a radiofrequency probe. I elected to treat the biceps tendon tear and the SLAP lesion with a biceps tenodesis and so a radiofrequency probe was used to perform a biceps tenotomy. After performing an extensive debridement of the glenohumeral joint and a biceps tenotomy, I repositioned the instruments into the subacromial space where a bur, a shaver and a radiofrequency probe were used to perform an arthroscopic subacromial decompression and bursectomy using standard technique. The bur was used to remove the subacromial bone. Please note that the full-thickness rotator cuff tear was debrided extensively from the articular surface side using a torpedo shaver before repositioning the instruments into the subacromial space. I then abducted and externally rotated the shoulder. I used a radiofrequency probe and a straight snap to dissect out the torn biceps tendon from the bicipital groove. I then used a scorpion suture passer to pass two luggage-tag sutures through the proximal long head of the biceps tendon in a baseball stitch fashion. I then secured fixation in the proximal aspect of the bicipital groove using a 4.75 BioComposite SwiveLock anchor from Arthrex. Excellent stable fixation was achieved. Redundant tendon proximal to the tenodesis site was resected using a torpedo shaver. I then repaired the full-thickness rotator cuff tear in a double row SpeedBridge technique with two 4.75 BioComposite SwiveLock anchors from Arthrex in the medial row and two 5.5 BioComposite SwiveLock anchors from Arthrex in the lateral row. Excellent stable fixation was achieved. At that point, a bur, a shaver and a radiofrequency probe were used to perform a distal clavicle resection removing the distal 1 cm of the clavicle. At that point, the instruments were removed. The portal sites were closed using 2-0 Monocryl in a subcuticular fashion. Steri-Strips were applied. The subacromial space was injected with 5 mL of platelet-rich plasma obtained from the patient prior to the start of the case.
The right shoulder and upper extremity were then prepped and draped in a standard sterile fashion. The glenohumeral joint was injected with 10 mL of 0.25% Marcaine with epinephrine. A standard posterior portal and anterosuperior portal and straight lateral portals were established and diagnostic arthroscopy was performed. The patient had severe tearing of the intraarticular portion of the long head of the biceps tendon extending into a large devastating type 2 SLAP lesion. The entire circumference of the labrum was horribly torn. There was a small amount of chondromalacia along the anterior, inferior chondral labral junction of the glenoid. There was a full-thickness rotator cuff tear measuring 4 cm in width. The axillary pouch was normal. The middle glenohumeral ligament labral complex and the inferior glenohumeral ligament labral complex was intact. The subscapularis tendon was intact. I proceeded to perform an extensive debridement of the glenohumeral joint using a torpedo shaver. This included extensively debriding the biceps tendon, extensively debriding the SLAP lesion, extensively debriding the rotator cuff tear, extensively debriding the labral tear, performing a chondroplasty in the anterior chondral labral junction of the glenoid and extensively debriding the synovitis within the glenohumeral joint using a torpedo shaver and a radiofrequency probe. I elected to treat the biceps tendon tear and the SLAP lesion with a biceps tenodesis and so a radiofrequency probe was used to perform a biceps tenotomy. After performing an extensive debridement of the glenohumeral joint and a biceps tenotomy, I repositioned the instruments into the subacromial space where a bur, a shaver and a radiofrequency probe were used to perform an arthroscopic subacromial decompression and bursectomy using standard technique. The bur was used to remove the subacromial bone. Please note that the full-thickness rotator cuff tear was debrided extensively from the articular surface side using a torpedo shaver before repositioning the instruments into the subacromial space. I then abducted and externally rotated the shoulder. I used a radiofrequency probe and a straight snap to dissect out the torn biceps tendon from the bicipital groove. I then used a scorpion suture passer to pass two luggage-tag sutures through the proximal long head of the biceps tendon in a baseball stitch fashion. I then secured fixation in the proximal aspect of the bicipital groove using a 4.75 BioComposite SwiveLock anchor from Arthrex. Excellent stable fixation was achieved. Redundant tendon proximal to the tenodesis site was resected using a torpedo shaver. I then repaired the full-thickness rotator cuff tear in a double row SpeedBridge technique with two 4.75 BioComposite SwiveLock anchors from Arthrex in the medial row and two 5.5 BioComposite SwiveLock anchors from Arthrex in the lateral row. Excellent stable fixation was achieved. At that point, a bur, a shaver and a radiofrequency probe were used to perform a distal clavicle resection removing the distal 1 cm of the clavicle. At that point, the instruments were removed. The portal sites were closed using 2-0 Monocryl in a subcuticular fashion. Steri-Strips were applied. The subacromial space was injected with 5 mL of platelet-rich plasma obtained from the patient prior to the start of the case.
