Our doc actually wants to bill both 27422 & 27427, but I feel it should be one or the other (27422)
DX: Recurrent dislocating right patella
Procedure: Medial patellofemoral ligament reconstruction with gracilis double looped allograft tendon fixed on the patella with two swivel lock anchors and on the femur with one 6mm x 23mm interference screw with advancement of vastus medialis.
A lateral view was used with the image intensifier to identify a line above the Blumensaat's line just above the posterior cortex of the lateral cortex about 1cm and about 1cm to 2cm proximal and proximity of the abductor tubercle. At this point, a Beath pin was drilled from medial to lateral confirmed on the image intensifier. After this time, t he medial patella was marked with a marking pen and an incision was made in the superior half of the patella down to the capsule. The soft tissue was advanced of the anterior surface of the patella and a drill hole was made with a 2.4 drill bit to a 25mm depth and one distal and parallel 1.5mm distal to that. These were over drilled with a 4.5 drill and a fiber looped whipstitch was placed 10mm on both limbs of the gracilis. Then two sutures from one limb was placed with a swivel locked and inserted superiorly until it was flushed with the cortex and then the inserter was removed after removing the holding sutures and the excess suture for the fiber wire was cut. The second limb was placed inferiorly or distally. Tension was placed on the graft, which pulled the patella over with good fixation. The beath pin was over drilled with a 6.5 drill to both cortices. A tunnel was made underneath the vastus medialis to the beath pin posteriorly, where a clamp was placed grabbing the sutures from the mid portion of the gracilis allograft. Once this was accomplished, a clamp was placed underneath the gracilis to make sure equal tension and passing of the graft was made through the soft tissue tunnel. The sutures wereplaced with beath pin. The Beath pin was pulled out laterally with the sutures. The sutures were pulled pulling the graft into the tunnel with the knee flexed at 30 degrees. Range of motion was placed throughthe knee and make sure there was no gapping or loosening of the graft until it was snug with pressue lateral to medially. Pulling tension on the graft to the lateral sutures, a guidewire was placed in the hole and a 6mm x 23mm bioabsorbable inerteference screw was inserted and tightened until it was significantly tight. The patella was moved over medially and was shown to be with good fixation. The vastus medialis was advanced through the soft tissue anteriorly of the patell a with 2-0 vicryl interrupted sutures.
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