kathydaniel
Networker
Would 29881-59 & 27331 be appropriate?
INDICATIONS FOR PROCEDURE: The patient is a 23 year old female who has been having some right knee pain for the past several months. An MRI did not reveal any significant intraarticular damage; however, she had persistent in an area over the lateral aspect of the patellar tendon that felt like it might have been a loose body. There was no evidence of this, however, on the MRI. She wished to proceed with surgical intervention as there was not getting any better despite conservative care. Consent was obtained and questions were answered to her satisfaction.
DESCRIPTION OF PROCEDURE: The patient was taken to the operative suite and placed under general anesthesia by the Department of Anesthesia. Her right lower extremity was placed in arthroscopic leg holder and prepped and draped in a normal sterile fashion. A time-out was confirmed. Standard arthroscopic portals were made, Evaluation of the patellofemoral joint revealed there was grade II change of the patella and grade-zero change in the trochlear groove. There was evidence of some chondral fraying of the medial aspect of the patella. Therefore, chondroplasty was performed to this compartment. Evaluation of the medial joint revealed there was grade-zero change in the medial femoral condyle and grade-zero change in the medial tibial plateau. There was no evidence of medial menisucus tear. Evaluation of the notch revealed the ACL was intact and stable to probing.
There was a hypertrophic ligamentum mucosum that was excised using a shaver. Evaluation of the lateral joint revealed there was grade-zero change in the lateral femoral condyle and grade-zero change in the lateral tibial plateau. There was evidence of a lateral meniscus tear of the midbody. Therefore, a partial lateral meniscectomy was performed using a combination of basket forceps as well as the shaver, I did debride the retropatellar fat pad especially on thelateral aspect as this is where most of her pain was. I did saw using the scope in both medial as well as the lateral portals, and when the scope was in the medial portal, I pushed on the lateral aspect, the lateral portal region so as to feel what is the structure that she was complaining about preoperatively.
I therefore opened the lateral portals for approximately 1 cm to L5 cm incisions and was able to identify some thickened scar like tissue where in the area which she was complaining about. Therefore, this was removed using a combination of blunt as well as sharp dissection techniques. Copious irrigation was performed of this and closure was performed using 3-0 nylon.
I did inject 28 mL of O.25% Marcaine as well as 1 mL each of dexamethasone and Depo-Medrol in the superolateral portal prior to its closure. Sterile dressing was applied consisting of 4x4's, ABDs, Sof-Rol, Polar Pack, and an Ace wrap. The patient was extubated by the Department of Anesthesia and transferred to PACU in apparently stable condition.
INDICATIONS FOR PROCEDURE: The patient is a 23 year old female who has been having some right knee pain for the past several months. An MRI did not reveal any significant intraarticular damage; however, she had persistent in an area over the lateral aspect of the patellar tendon that felt like it might have been a loose body. There was no evidence of this, however, on the MRI. She wished to proceed with surgical intervention as there was not getting any better despite conservative care. Consent was obtained and questions were answered to her satisfaction.
DESCRIPTION OF PROCEDURE: The patient was taken to the operative suite and placed under general anesthesia by the Department of Anesthesia. Her right lower extremity was placed in arthroscopic leg holder and prepped and draped in a normal sterile fashion. A time-out was confirmed. Standard arthroscopic portals were made, Evaluation of the patellofemoral joint revealed there was grade II change of the patella and grade-zero change in the trochlear groove. There was evidence of some chondral fraying of the medial aspect of the patella. Therefore, chondroplasty was performed to this compartment. Evaluation of the medial joint revealed there was grade-zero change in the medial femoral condyle and grade-zero change in the medial tibial plateau. There was no evidence of medial menisucus tear. Evaluation of the notch revealed the ACL was intact and stable to probing.
There was a hypertrophic ligamentum mucosum that was excised using a shaver. Evaluation of the lateral joint revealed there was grade-zero change in the lateral femoral condyle and grade-zero change in the lateral tibial plateau. There was evidence of a lateral meniscus tear of the midbody. Therefore, a partial lateral meniscectomy was performed using a combination of basket forceps as well as the shaver, I did debride the retropatellar fat pad especially on thelateral aspect as this is where most of her pain was. I did saw using the scope in both medial as well as the lateral portals, and when the scope was in the medial portal, I pushed on the lateral aspect, the lateral portal region so as to feel what is the structure that she was complaining about preoperatively.
I therefore opened the lateral portals for approximately 1 cm to L5 cm incisions and was able to identify some thickened scar like tissue where in the area which she was complaining about. Therefore, this was removed using a combination of blunt as well as sharp dissection techniques. Copious irrigation was performed of this and closure was performed using 3-0 nylon.
I did inject 28 mL of O.25% Marcaine as well as 1 mL each of dexamethasone and Depo-Medrol in the superolateral portal prior to its closure. Sterile dressing was applied consisting of 4x4's, ABDs, Sof-Rol, Polar Pack, and an Ace wrap. The patient was extubated by the Department of Anesthesia and transferred to PACU in apparently stable condition.
