tbensonite
Guest
Hello All,
I would sure appreciate another opinion on this surgery note. Thanks much
Postoperative Diagnosis: Avulsion of patellar tendon, left total knee replacement.
Procedures Performed: 1. Revision of left total knee replacement with polyethylene exchange.
2. Repair of patellar tendon with primary repair to proximal tibia of avulsion of bone and then secondary grafting with amniotic tissue allograft for tissue defect.
Operative Findings: Include avulsion of the inferior aspect of the patellar tendon appeared to avulse of the proximal tibia, involving 90% of the tendon. This had avulsed proximally, we are able to retrieve this, take it back down to it's anatomic position. This was done after resting the proximal tibial bone. This was done with two #5.5 FiberWire suture anchors were sewn in a figure-of-eight fashion back down into the bone. In addition to this, we used for the repair with #5 FiberWire suture. Multiple #5 FiberWire sutures, and an anatomic repair was obtained in this fashion. In addition to this, we augmented the repair with amniotic tissue allograft, and this was injected into the area of primary repair. We then augmented the repair also with a semimembranosus allograft.
INDICATIONS FOR PROCEDURE: She underwent complex primary of TKR, unfortunately, she has developed an extensor lag and has developed a chronic avulsion of the proximal tibia. She continues to have difficulty with this and now we are proceeding with revision with exchange of polyethylene for stability and then we will perform primary repair for the avulsed tendon.
PROCEDURE IN DETAIL: ...Anterior approcah to the knee joint was undertaken, excised the previous incision, dissected sharply down to the level of quadriceps. Small flaps were created medially and laterally and a mini mid-vastus arthrotomy was performed. It was very easy to see where the patellar tendon had avulsed from the proximal tibia. The tendon itself was freshened. The proximal bone was freshened as well. We flexed the knee to 90 degrees and checked the femoral and tibial components, which were all fixed and did not need to be revised. We simply revised the tibial polyethylene to a size 14 anterior constrained polyethylene for some constrain. We then primarily repaired after freshening the proximal tibial bone, primarily repaired the area into the proximal tibia using #5.5 suture anchors and #5 FiberWire suture. This was repaired proximally into the proximal tibia. We then flexed the knee well passed to 90 degrees and the repair was extremely stable, did not want to pullback after avulse. We irrigated with 3 liters of antibiotic saline solution.. We then augmented the repair with amniotic tissue allograft. This was sewn into place and tacked into place gently with a semimenbranosus allograft on top of this. The arthrotomy was closed with #2FiberWire, subcutaneous tissue was closed with 2-0 Vicryl, and skin closed with staples. etc.
So,I'm thinking 27486-52, 27381(or 27380). Any assistance would be greatly appreciated. Just so confused with this one.
I would sure appreciate another opinion on this surgery note. Thanks much
Postoperative Diagnosis: Avulsion of patellar tendon, left total knee replacement.
Procedures Performed: 1. Revision of left total knee replacement with polyethylene exchange.
2. Repair of patellar tendon with primary repair to proximal tibia of avulsion of bone and then secondary grafting with amniotic tissue allograft for tissue defect.
Operative Findings: Include avulsion of the inferior aspect of the patellar tendon appeared to avulse of the proximal tibia, involving 90% of the tendon. This had avulsed proximally, we are able to retrieve this, take it back down to it's anatomic position. This was done after resting the proximal tibial bone. This was done with two #5.5 FiberWire suture anchors were sewn in a figure-of-eight fashion back down into the bone. In addition to this, we used for the repair with #5 FiberWire suture. Multiple #5 FiberWire sutures, and an anatomic repair was obtained in this fashion. In addition to this, we augmented the repair with amniotic tissue allograft, and this was injected into the area of primary repair. We then augmented the repair also with a semimembranosus allograft.
INDICATIONS FOR PROCEDURE: She underwent complex primary of TKR, unfortunately, she has developed an extensor lag and has developed a chronic avulsion of the proximal tibia. She continues to have difficulty with this and now we are proceeding with revision with exchange of polyethylene for stability and then we will perform primary repair for the avulsed tendon.
PROCEDURE IN DETAIL: ...Anterior approcah to the knee joint was undertaken, excised the previous incision, dissected sharply down to the level of quadriceps. Small flaps were created medially and laterally and a mini mid-vastus arthrotomy was performed. It was very easy to see where the patellar tendon had avulsed from the proximal tibia. The tendon itself was freshened. The proximal bone was freshened as well. We flexed the knee to 90 degrees and checked the femoral and tibial components, which were all fixed and did not need to be revised. We simply revised the tibial polyethylene to a size 14 anterior constrained polyethylene for some constrain. We then primarily repaired after freshening the proximal tibial bone, primarily repaired the area into the proximal tibia using #5.5 suture anchors and #5 FiberWire suture. This was repaired proximally into the proximal tibia. We then flexed the knee well passed to 90 degrees and the repair was extremely stable, did not want to pullback after avulse. We irrigated with 3 liters of antibiotic saline solution.. We then augmented the repair with amniotic tissue allograft. This was sewn into place and tacked into place gently with a semimenbranosus allograft on top of this. The arthrotomy was closed with #2FiberWire, subcutaneous tissue was closed with 2-0 Vicryl, and skin closed with staples. etc.
So,I'm thinking 27486-52, 27381(or 27380). Any assistance would be greatly appreciated. Just so confused with this one.