kellit21
Guru
I need to make sure I am coding this correctly...
1. Manipulation under anesthesia
2. Arthroscopic partial medial menisectomy (29881... manipulation included???)
3. Arthroscopic removal of ACL and release off the posterior capsule (27435)
4. Arthroscopic-assisted ACL reconstruction using hamstring autograft. (29888)
Inferolateral portal was made and scope introduced into the joint. Patellofemoral joint was pristine. Lateral compartment was intact. The ACL was folded back and toen and adgered to the posterior capsule. The medial compartment showed no evidence of articular damage. There was a longitudinal tear with two flaps, two with buckled and folded up underneath the meniscus that with probing could be removed and then resected back to stable tissue taking about 60% of the depth of the poaterior horn of the medial meniscus. The ACL was removed in its enterity. There was a few strands still attached that were removed and the strands and the debulking of the ACL were started to adhere to the posterior aspect of the capsule was performed. This allowed significant improvement in flexion, basically the patient had full felxion at this time still had some difficulty with extension, but with stretching with periods of five minutes each, the knee could be brought out to full extension and the bouncy enpoint was improved. The hamstrings were harvested in the usual manner through a seperate incision without difficulty. I contmiued with the motchplasty and they were drilled to tibial tunnel to an 8 with PCL referencing guide, posteriror wall and the posterior over the top position, though some occasional slight discomfort encountered and then the 6 offset guide was used to drill the femoral socket, which measured right at a 35 and which hit the cortical bone. The graft was then able to be placed into the femoral socket after using the Transfix systemand placing the nitinol wire and it sat easily into the femoral socket, the Transfix pin was placed across with good purchase obtained. The grafts felt very isometric:there was good clearance in the lateral wall and at full extension. Excellent purchase obtained.
1. Manipulation under anesthesia
2. Arthroscopic partial medial menisectomy (29881... manipulation included???)
3. Arthroscopic removal of ACL and release off the posterior capsule (27435)
4. Arthroscopic-assisted ACL reconstruction using hamstring autograft. (29888)
Inferolateral portal was made and scope introduced into the joint. Patellofemoral joint was pristine. Lateral compartment was intact. The ACL was folded back and toen and adgered to the posterior capsule. The medial compartment showed no evidence of articular damage. There was a longitudinal tear with two flaps, two with buckled and folded up underneath the meniscus that with probing could be removed and then resected back to stable tissue taking about 60% of the depth of the poaterior horn of the medial meniscus. The ACL was removed in its enterity. There was a few strands still attached that were removed and the strands and the debulking of the ACL were started to adhere to the posterior aspect of the capsule was performed. This allowed significant improvement in flexion, basically the patient had full felxion at this time still had some difficulty with extension, but with stretching with periods of five minutes each, the knee could be brought out to full extension and the bouncy enpoint was improved. The hamstrings were harvested in the usual manner through a seperate incision without difficulty. I contmiued with the motchplasty and they were drilled to tibial tunnel to an 8 with PCL referencing guide, posteriror wall and the posterior over the top position, though some occasional slight discomfort encountered and then the 6 offset guide was used to drill the femoral socket, which measured right at a 35 and which hit the cortical bone. The graft was then able to be placed into the femoral socket after using the Transfix systemand placing the nitinol wire and it sat easily into the femoral socket, the Transfix pin was placed across with good purchase obtained. The grafts felt very isometric:there was good clearance in the lateral wall and at full extension. Excellent purchase obtained.