Good Morning,

I am having trouble coding this procedure; any thoughts would be appreciated.

1. Examination under anesthesia.
2. Arthroscopy.
3. Removal of screw fragments from the tibial interference tunnel site.
4. Insertion of two Smith and Nephew TruFit plugs left knee.

DESCRIPTION OF PROCEDURE: The patient was placed under satisfactory general anesthesia. The left lower extremity was examined with 1+ Lachman's at most and negative pivot shift, no varus or valgus instability. The left knee and lower extremity was prepped with Betadine and Betadine-draped in the usual fashion. An Esmarch bandage was used to exsanguinate the limb and a proximally applied thigh tourniquet was inflated to 300 mmHg.

Skin incisions were made through the previous inferomedial and inferolateral arthroscopic portals. Cannulae were inserted and the arthroscope positioned in the suprapatellar pouch. The joint was insufflated with saline solution. No pathology was noted in the suprapatellar pouch or the patellofemoral surface.

The scope was directed into the medial compartment. The previously repaired medial meniscus appeared to be stable and this was verified by thorough probing of the meniscus with the meniscal probe. During this process a separate mid anterior portal was established by needle localization, stab wound and cannula introduction. The anterior cruciate ligament was visualized and felt to be normal with no significant attenuation. In the lateral compartment the lateral meniscus and articular surfaces were normal.

All arthroscopic instruments were removed at this point. A skin incision was then made over the medial incision from the previous hamstring graft procedure. This was carried through the previous scar through the subcutaneous tissue directly down to the medial hamstrings and periosteum overlying the tibial tunnel. These were longitudinally incised and elevated to expose the tibial tunnel of the proximal tibia. Some of the previously placed Bio RCI screw was still in place extending out enough to create impingement and irritation on the hamstrings and pes anserine bursal area. Using sharp dissection as well as a curet and a rongeur these screw fragments were removed.

There were two previously placed screw fragments and they created two separate tunnels and around an excellent bony bridge from the bone plug on the tibial side of the graft. These tunnels were debrided thoroughly with a curet and incised using the OATS sizer ending up with one tunnel being an 11 mm size and the other tunnel being a 7 mm size. Then the 7 mm TruFit BCS Smith and Nephew plug was inserted to fill the most distal hole and then an 11 mm similar plug inserted to fil the more proximal hole.

Thanks for your help,
Gail Steeves, CPC