I need some help here. Would 27385 and 27350 be appropriate here?
Preoperative Diagnosis
Right open quadriceps tendon rupture, recurrent. Traumatic arthrotomy. Wound dehiscence.
Postoperative Diagnosis
Right open quadriceps tendon rupture, recurrent. Traumatic arthrotomy. Wound dehiscence. Patella fracture involving the superolateral patella approximately 1 cm by 3 mm.
Operation
Right open quadriceps tendon repair with thorough irrigation and debridement of traumatic arthrotomy. Excision of patella avulsion fragment.
Anesthesia
General
Estimated Blood Loss
100 mL
Findings
Patient had wound dehiscence with recurrent rupture of the quadriceps tendon with communication to the open wound as well as intra-articularly. Due to the traumatic open arthrotomy patient was taken for open irrigation debridement with repair of quadriceps tendon. There was no significant retraction of the tendon and reduction was performed to the superior pole of the patella with minimal excess tension. Once the repair was performed the knee was able to range from 0-70 degrees with no gapping.
Specimen(s)
None
Complications
None
Technique
Patient was seen in the preoperative holding area. The correct operative site was marked. Verbal and written consent was obtained. He was transferred to the operative suite placed supine on the operating table. If given the benefit of general anesthesia by the anesthesia team. Right lower extremity was then prepped and draped in a normal sterile fashion. Time-out was performed and all those in attendance were in agreement the correct operative site and procedure to be performed.
An 11 blade scalpel was used to make an anterior longitudinal incision involving the previous incision and extending distally to the proximal tibia. Blunt and sharp dissection was undertaken to develop full-thickness skin flaps and the quadriceps tendon recurrent rupture was visualized. Previous suture was removed and rongeur was undertaken to the fibrous tissue. 6 L of sterile saline was then irrigated throughout the joint and soft tissues. Once again a rongeur was used to free all soft tissue and fibrous tissue from the superior pole of the patella until and a bleeding bone bed was encountered. Sharp and blunt debridement was performed of the distal quadriceps tendon and this was mobilized and a standard fashion. Arthrex suture tape was then used to Krackow the quadriceps tendon both medially and laterally with 4 limbs. Using a 2 0 drill bit 3 bone tunnels were drilled longitudinally through the patella. Using a passing suture due to then passed through the bone tunnels and then tied over the distal bone bridge with the knee held in extension and the quadriceps tendon reduced to the superior pole of the patella. Once this was secured in place a 2. FiberWire was used to over sew the quadriceps tendon bone junction to further secure the reapproximation. Attendant utilizing a suture tape the quadriceps tendon was sutured in an inverted Unit through the tendon and down to the retinaculum and secured into the proximal tibia with 2, 4.75mm SwiveLock anchors. The knee was taken through range of motion and found to be from 0-70 with no gapping at the repair site at the proximal patella. Once again sterile saline was irrigated throughout the wound and the retinaculum was reapproximated with a 1. Vicryl in a figure-of-eight fashion. Skin was reapproximated with a 2 0 Vicryl in inverted subcuticular fashion. Skin staples were then utilized. Incision was covered with Xeroform 4 x 4 ABD soft roll and Ace wrap. He was placed in the immobilizer and transferred to PACU in stable condition. All needle and scrubbed counts were correct in the case x2.
Tourniquet was used at 300 mm Hg for a total of 2 hr.
The services of a 1st assistant ARNP were necessary for this case due to the need for well trained surgical assistance for retractor placement and use. As well as the complex nature of the recurrent and open quadriceps tendon tear with associated traumatic arthrotomy, as well as obesity, making the case more technically demanding. The 1st assistant provided improved visualization throughout the surgery as well as assisted in proper patient positioning and preparation. They also used instruments under my direction in order to properly prepare the bone for implant fixation in appropriately securing the tendon to the proximal pole of patella.
Preoperative Diagnosis
Right open quadriceps tendon rupture, recurrent. Traumatic arthrotomy. Wound dehiscence.
Postoperative Diagnosis
Right open quadriceps tendon rupture, recurrent. Traumatic arthrotomy. Wound dehiscence. Patella fracture involving the superolateral patella approximately 1 cm by 3 mm.
Operation
Right open quadriceps tendon repair with thorough irrigation and debridement of traumatic arthrotomy. Excision of patella avulsion fragment.
Anesthesia
General
Estimated Blood Loss
100 mL
Findings
Patient had wound dehiscence with recurrent rupture of the quadriceps tendon with communication to the open wound as well as intra-articularly. Due to the traumatic open arthrotomy patient was taken for open irrigation debridement with repair of quadriceps tendon. There was no significant retraction of the tendon and reduction was performed to the superior pole of the patella with minimal excess tension. Once the repair was performed the knee was able to range from 0-70 degrees with no gapping.
Specimen(s)
None
Complications
None
Technique
Patient was seen in the preoperative holding area. The correct operative site was marked. Verbal and written consent was obtained. He was transferred to the operative suite placed supine on the operating table. If given the benefit of general anesthesia by the anesthesia team. Right lower extremity was then prepped and draped in a normal sterile fashion. Time-out was performed and all those in attendance were in agreement the correct operative site and procedure to be performed.
An 11 blade scalpel was used to make an anterior longitudinal incision involving the previous incision and extending distally to the proximal tibia. Blunt and sharp dissection was undertaken to develop full-thickness skin flaps and the quadriceps tendon recurrent rupture was visualized. Previous suture was removed and rongeur was undertaken to the fibrous tissue. 6 L of sterile saline was then irrigated throughout the joint and soft tissues. Once again a rongeur was used to free all soft tissue and fibrous tissue from the superior pole of the patella until and a bleeding bone bed was encountered. Sharp and blunt debridement was performed of the distal quadriceps tendon and this was mobilized and a standard fashion. Arthrex suture tape was then used to Krackow the quadriceps tendon both medially and laterally with 4 limbs. Using a 2 0 drill bit 3 bone tunnels were drilled longitudinally through the patella. Using a passing suture due to then passed through the bone tunnels and then tied over the distal bone bridge with the knee held in extension and the quadriceps tendon reduced to the superior pole of the patella. Once this was secured in place a 2. FiberWire was used to over sew the quadriceps tendon bone junction to further secure the reapproximation. Attendant utilizing a suture tape the quadriceps tendon was sutured in an inverted Unit through the tendon and down to the retinaculum and secured into the proximal tibia with 2, 4.75mm SwiveLock anchors. The knee was taken through range of motion and found to be from 0-70 with no gapping at the repair site at the proximal patella. Once again sterile saline was irrigated throughout the wound and the retinaculum was reapproximated with a 1. Vicryl in a figure-of-eight fashion. Skin was reapproximated with a 2 0 Vicryl in inverted subcuticular fashion. Skin staples were then utilized. Incision was covered with Xeroform 4 x 4 ABD soft roll and Ace wrap. He was placed in the immobilizer and transferred to PACU in stable condition. All needle and scrubbed counts were correct in the case x2.
Tourniquet was used at 300 mm Hg for a total of 2 hr.
The services of a 1st assistant ARNP were necessary for this case due to the need for well trained surgical assistance for retractor placement and use. As well as the complex nature of the recurrent and open quadriceps tendon tear with associated traumatic arthrotomy, as well as obesity, making the case more technically demanding. The 1st assistant provided improved visualization throughout the surgery as well as assisted in proper patient positioning and preparation. They also used instruments under my direction in order to properly prepare the bone for implant fixation in appropriately securing the tendon to the proximal pole of patella.