Achilles Tendon Rupture

Joyce Burchett

Mount Auburn, IL
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Need help understanding when to use 27650 & 27654. CPT 27650 or 27654 & 28119?
Proc: Achilles tendon repair utilizing a Biomet Lacto Screw 5.5 x2 & Graft Jacket 4X7
Attention directed to posterior aspect Rt ankle where a linear incision was placed. This incision was deepened with sharp & blunt dissection with care being taken to identify, retract, and isolate out all neurovascular structures & to coagulate any superficial bleeding vessels. The rupture was identified. It had retracted about 2 cm proximally to the insertion at the posterior aspect of the calcaneus. Approximately 2cm of distal free end of the tendon was necrotic. This was transected & passed off the surgical field. Blood clots were aspirated. The area was copiously flushed.
Pt. had previously suffered from retrocalcaneal exostosis with tendinitis. Therefore, we performed a linear incision at the posterior aspect of the calcaneus. All periosteal tissue was carefully dissected both medially & laterally. The exostosis was removed utilizing a high-speed oscillating saw. Utilizing an oscillating rasp, we then burrd down the posterior aspect. There was a small portion that we fenestrated proximally with a 0.045 K-wire. After doing measurements, it was decided that we needed to use a 4X7 Graft Jacket max.
This was wrapped around the proximal healthy tendon & sutured to it first. A small portion of this was transected due to the overlap.