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Thread: MPFL Reconstruction

  1. #1

    Default MPFL Reconstruction

    AAPC: Back to School
    Hi All!

    Can anyone help me coding an open medial patellofemoral ligament reconstruction with allograft semitendinosis?

    Really would appreciate it!!

    Thank you.


  2. #2
    Join Date
    Apr 2007
    Long Island/New York


    Quote Originally Posted by Desperate Denise View Post
    Hi All!

    Can anyone help me coding an open medial patellofemoral ligament reconstruction with allograft semitendinosis?

    Really would appreciate it!!

    Thank you.

    Look at either 27422 or 27427 depending on documentation..

  3. #3

    Post MPFL REcon

    Thank NYYANKEES - I was in that ballpark but the doc asked me to check it out with colleagues. The problem is I cannot tell if it is extra-articular or intra-articular or both - not getting much help from the docs and I cannot explain why.

    POSTOPERATIVE DIAGNOSIS: Right knee recurrent patella instability.

    1. Right knee examination under anesthesia.
    2. Right knee arthroscopy.
    4. Right knee open medial patellofemoral ligament reconstruction with
    allograft semitendinosis.

    WHAT WAS DONE: The patient was brought into the preoperative area.
    Site and side were identified. She was then brought in the operating
    room and placed supine on the operating room table. Bony prominences
    were padded appropriately. LMA anesthesia induced. Examination of
    the left knee under anesthesia revealed 1 cm of patella glide with the
    knee in full extension, 1 cm of patella glide with the knee in 30
    degrees of flexion. When compared with the operative extremity, the
    right knee had 1.5 cm of patella glide laterally in full extension and
    at 30 degrees of flexion was able to be fully dislocated. The right
    lower extremity was then prepped and draped in a sterile fashion.
    Bony landmarks of the anterior aspect of the knee were marked with a
    marking pen including the patella, anteromedial and anterolateral
    portal sites. An 11-blade scalpel was used to incise the skin of the
    area of the anterolateral portal and a diagnostic arthroscopy was
    begun. There was no evidence of chondromalacia of the undersurface of
    patella or femoral trochlea. The patella was easily able to be
    dislocated over the lateral aspect of the femoral trochlea.
    Diagnostic arthroscopy continued to medial compartment. Medial
    femoral condyle, medial tibial plateau and medial meniscus showed no
    evidence of chondromalacia or tearing. Intracondylar notch and ACL
    was in good condition. The lateral gutter was entered. There was no
    evidence of chondromalacia of the lateral femoral condyle or lateral
    tibial plateau, no evidence of lateral meniscal tear. Additional
    pictures were taken showing that the patella easily subluxated out of
    the femoral trochlear sulcus. Once the diagnostic arthroscopy was
    complete, tourniquet was inflated. A longitudinal incision was made
    over the medial 1/3 of the patella. Blunt dissection was carried down
    to the extensor retinaculum. The 3 layers of the knee capsule were
    then identified. The interval between layers 2 and 3 was identified.
    The medial border of the patella was cleared of all soft tissue and
    decorticated using a rongeur as well as a curette. Once this layer
    between 2 and 3 was identified, a blunt mosquito clamp was used to
    create a path toward the eventual site of the femoral tunnel.
    Fluoroscopic images were obtained in the true lateral plane to look
    for the anatomic attachment site of the MPFL on the femur. Once this
    was localized via fluoroscopy, incision was made to the skin and blunt
    dissection was carried down through layer 1 of the medial knee
    capsule. A short Beath pin was placed in the area of the anatomic
    attachment of the MPFL and advanced through the femur and out the
    lateral aspect of the femur. Its position was checked via fluoroscopy
    and was felt to be adequate in all planes. A stitch was passed from
    the patella incision to the posteromedial incision, and a length
    change test was performed. The position of the MPFL on the femur was
    felt to be adequate. A #7 reamer was placed over the Beath pin and
    advanced to a depth of 25. Once the reaming was complete, the graft
    was being prepared on the back table. This consisted of doubled over
    semitendinosis tendon with a proximal 20 mm of tendon whipstitch
    together and each of the 2 ends then subsequently whipstitched and
    separated. The doubled over end was passed into the femoral tunnel
    using the Beath pin, and once it was well secured, a 7-0 bioabsorbable
    screw was placed over a nitinol wire. Care was taken to try to place
    the screw posterior or posteroinferior to the graft. Once the graft
    was secured, it was tested with longitudinal traction and felt to be
    stable within the femoral tunnel. A Kelly clamp was passed from the
    anterior incision to the posteromedial incision, and the graft was
    passed in a standard fashion. Two double-loaded bio suture tacks were
    placed into the medial border of the patella. One limb of each of the
    2 suture tacks was placed through the graft. The leg was brought
    through range of motion; it was felt to be stable. There was no slack
    in the graft, but no tension. It was able to be ranged from full
    extension to approximately 120 degrees without excessive tension in
    the graft. There was approximately 1 cm worth of lateral translation
    with the knee in about 30 degrees of knee flexion. This was similar
    to the contralateral side. The graft was secured additionally with
    the second set of stitches within the bio suture tacks. Once again,
    range of motion was performed. The incised extensor mechanism was
    then reached over the anterior aspect of the knee and medial
    patellofemoral ligament repair. Copious irrigation was then
    performed. Subcutaneous tissue was closed with 2-0 Vicryl in
    interrupted fashion, skin edges approximated with 3-0 Prolene in a
    subcuticular manner. Half inch Steri-Strips were cut in half and used
    to approximate skin edges as well. Marcaine 0.25% with epinephrine
    was injected around the incision. A sterile dressing was applied.
    Last edited by Desperate Denise; 08-28-2010 at 11:05 AM.

  4. #4
    Join Date
    Apr 2007
    Long Island/New York


    MPFL is extra-articular - I believe only the ACL and PCL are intra-articular.

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