cclarson
Guru
Hello everyone, I'm trying to figure out how to code the fixation of an osteochondral defect. Normally I would go for 27415 or 27416, but neither an allograft or autograft was used. I'm also looking at 27524. Anyone familiar with this type of procedure? Any help would be deeply appreciated. Thank you!
POSTOPERATIVE DIAGNOSIS: Left knee patellar osteochondral defect.
PROCEDURE PERFORMED: Open surgical fixation of left knee osteochondral defect.
IMPLANTS USED: Arthrex BioCompression chondral screw x1 with chondral dart x2.
INDICATIONS FOR SURGERY: The patient is a 17-year-old female who is a high-school soccer player. She had a noncontact injury to her left knee and sustained a dislocation of her patella. There is significant difficulty performing a reduction. She actually had to be transferred to the emergency department to have a reduction performed. She had persistent pain and swelling. She was referred to our practice. One of my partners saw and evaluated her and obtained an MRI. This showed a large osteochondral defect off the medial aspect of the patella. She was referred to me for surgical treatment options. I recommended open surgical fixation. I discussed the nature of the injury with the patient and her parents. We discussed that healing would depend on ability of her body to repair this osteochondral defect after stabilization. We discussed that she is likely to have long-term issues with patellofemoral pain, but if we could get this to heal, she should be able to return to sporting activities. The risks, benefits, and alternatives to open treatment of her injury were discussed including the risks of bleeding, infection, failure of any repairs, continued knee pain and dysfunction, and possible need for surgery down the roads, specifically if the fixation did not take and require a second surgical procedure. The patient and her parents understood and agreed to proceed.
DESCRIPTION OF PROCEDURE: The patient was identified and marked in the preoperative area. Her H&P and consent were signed and updated. She was taken to the operating room and intubated without complication. She was placed supine on the operating table. Her left lower extremity was prepped and draped in a normal sterile fashion. Preoperative antibiotics were given. A tourniquet was used on her left thigh.
After a surgical time-out was performed, we started by exsanguinating the limb and inflating the tourniquet to 300 mmHg. We used the anterior midline approach to the left knee. We then made a medial parapatellar arthrotomy. We worked carefully through the medial retinaculum.
Once we entered the knee, a large amount of bloody fluid was expressed. We looked carefully to identify the osteochondral fragment. The injury site on the patella was easily identified as soon as we came through the medial retinaculum. Eventually, we were able to find the cartilage fragment. It was actually over the lateral gutter but still had one soft tissue attachment inferiorly. We decided to leave this in place. We then debrided our recipient site back on the patella with a curate and made sure we had all bony fragments removed there. We drilled the recipient site with K-wires to make sure we had good bleeding bone exposed as well to increase our healing potentials as much as possible. The fragment that we placed back did not have much subchondral bone attached to it and was mostly a cartilaginous piece. We stabilized it back in its donor site, and we placed a couple of K-wires to hold it. I used the center K-wire through the main body of the fragment to serve as our anchor point for our screw. We drilled over this and then tapped over this and then placed a 16-mm chondral screw. We made sure to countersink this down below the articular surface, so it would not be prominent. This seemed to stabilize the fragment pretty well. We placed 2 chondral darts superiorly and inferiorly to stabilize this rotationally. I did not think that the piece was big enough to place another screw as I was worry that that would propagate injury between the two screw sites and later with no good fixation. Overall, I was pleased with our final fixation construct. We took images with our arthroscopy tower before and after fixation to show the defect as well as the repair. We did not have any significant step-off. I thought overall we had a good repair. We repaired the medial retinaculum with a series of running Vicryl suture. We closed the subcuticular layer with 2-0 Vicryl suture and then the skin with a running nylon suture. Sterile dressings were applied, and the tourniquet was released. She was awakened from anesthesia and taken to the recovery area in stable condition with a knee immobilizer in place.
POSTOPERATIVE DIAGNOSIS: Left knee patellar osteochondral defect.
PROCEDURE PERFORMED: Open surgical fixation of left knee osteochondral defect.
IMPLANTS USED: Arthrex BioCompression chondral screw x1 with chondral dart x2.
INDICATIONS FOR SURGERY: The patient is a 17-year-old female who is a high-school soccer player. She had a noncontact injury to her left knee and sustained a dislocation of her patella. There is significant difficulty performing a reduction. She actually had to be transferred to the emergency department to have a reduction performed. She had persistent pain and swelling. She was referred to our practice. One of my partners saw and evaluated her and obtained an MRI. This showed a large osteochondral defect off the medial aspect of the patella. She was referred to me for surgical treatment options. I recommended open surgical fixation. I discussed the nature of the injury with the patient and her parents. We discussed that healing would depend on ability of her body to repair this osteochondral defect after stabilization. We discussed that she is likely to have long-term issues with patellofemoral pain, but if we could get this to heal, she should be able to return to sporting activities. The risks, benefits, and alternatives to open treatment of her injury were discussed including the risks of bleeding, infection, failure of any repairs, continued knee pain and dysfunction, and possible need for surgery down the roads, specifically if the fixation did not take and require a second surgical procedure. The patient and her parents understood and agreed to proceed.
DESCRIPTION OF PROCEDURE: The patient was identified and marked in the preoperative area. Her H&P and consent were signed and updated. She was taken to the operating room and intubated without complication. She was placed supine on the operating table. Her left lower extremity was prepped and draped in a normal sterile fashion. Preoperative antibiotics were given. A tourniquet was used on her left thigh.
After a surgical time-out was performed, we started by exsanguinating the limb and inflating the tourniquet to 300 mmHg. We used the anterior midline approach to the left knee. We then made a medial parapatellar arthrotomy. We worked carefully through the medial retinaculum.
Once we entered the knee, a large amount of bloody fluid was expressed. We looked carefully to identify the osteochondral fragment. The injury site on the patella was easily identified as soon as we came through the medial retinaculum. Eventually, we were able to find the cartilage fragment. It was actually over the lateral gutter but still had one soft tissue attachment inferiorly. We decided to leave this in place. We then debrided our recipient site back on the patella with a curate and made sure we had all bony fragments removed there. We drilled the recipient site with K-wires to make sure we had good bleeding bone exposed as well to increase our healing potentials as much as possible. The fragment that we placed back did not have much subchondral bone attached to it and was mostly a cartilaginous piece. We stabilized it back in its donor site, and we placed a couple of K-wires to hold it. I used the center K-wire through the main body of the fragment to serve as our anchor point for our screw. We drilled over this and then tapped over this and then placed a 16-mm chondral screw. We made sure to countersink this down below the articular surface, so it would not be prominent. This seemed to stabilize the fragment pretty well. We placed 2 chondral darts superiorly and inferiorly to stabilize this rotationally. I did not think that the piece was big enough to place another screw as I was worry that that would propagate injury between the two screw sites and later with no good fixation. Overall, I was pleased with our final fixation construct. We took images with our arthroscopy tower before and after fixation to show the defect as well as the repair. We did not have any significant step-off. I thought overall we had a good repair. We repaired the medial retinaculum with a series of running Vicryl suture. We closed the subcuticular layer with 2-0 Vicryl suture and then the skin with a running nylon suture. Sterile dressings were applied, and the tourniquet was released. She was awakened from anesthesia and taken to the recovery area in stable condition with a knee immobilizer in place.