How do we know if it is 27427 or 27422

bmeech

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I know that it depends on the location of the approach as 27422:is anteriormedial and the 27427: is over the IT band but is the VMO involved both codes?scrubbed note:

We then proceeded with the MPFL reconstruction. We made a 3 cm incision centered over the superior medial patella. A skin knife was used to make the incision, and bovie electrocautery was used to dissect down to the superiormedial aspect of the patella. Care was taken to avoid violated the knee joint. Once our approach was established, we prepared our allograft.* On the back table, the gracilis allograft was whipshitched on both ends with fiberwire suture and pretensioned on the allograft tensioner. We measured the allograft which was 21 cm in length, and then sized it using the Arthrex sizers. It was of appriopiate length and diameter. We then turned our attention back to the patella. Under x-ray guidance, we placed 2 guidewires into the patella for the Arthex swivellock anchors. These were placed in a medial to lateral direction, with our superior wire 10-15 mm from the superior aspect of the patella, and our inferior guideline separated from our superior guidewire by at least 15-20 mm.* We confirmed their position with both AP and lateral fluroscopy. We then used the cannulated drill to drill both our swivel lock tunnels over the guidewires, taking care to not violate the lateral patellar cortex. We then passed our allograft whipstich sutures through the eyelet of our swivellock anchors, and inserted both anchors into the patella, achieving good purchase and passing our graft to the correct depth within the patella.

Using blunt dissection, we found a plane deep to the VMO to pass our graft on the femur, and made a 3 cm incision centered over our proposed anchor site on the femur. Blunt dissection was carried down to the medial aspect of the distal femur.* We used x-ray to obtain a perfect lateral of the knee, and inserted our guidewire slightly distal and anterior to Schottle's ponit on the femur in order to avoid violation of the physis. The guidewire position was confirmed on both AP and lateral xrays, and the cannulated drill was used to drill to the appropiate depth over the wire.* We then inserted a Bieth needle, and passed this from medial-to-lateral. We then tunneled our allograft deep to the VMO, brought it out of our medial distal femur incision, placed passing suture around it, and then using the Beith needle, passed the graft through our femoral tunnel. We confirmed our graft's passage through the tunnel, brought the knee to 30 degrees of flexion to tension our reconstruction, and inserted a nitinol guidewire for the arthex interference screw.* While maintaining tension on the graft, we placed our interference screw over the wire and placed this flush with the medial femoral cortex.* We then used xray to confirm tunnel placement, and our MPFL reconstruction was under the appropiate tension and the patella now had a good endpoint with lateral translation.
 
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