Would this be coded as 27380 or aq revision code?
Patellar tendon rupture/inferior pole patella fracture, right knee revision
Primary repair of patellar tendon to the patella.
INDICATIONS FOR OPERATION:
Brief History: Pleasant 74-year-old who underwent a revision
knee arthroplasty about 2 months prior. She fell about a week ago sustaining a
small avulsion off the inferior pole of her patellar but more importantly
complete rupture of her patellar tendon off the patella and loss of her
extensor mechanism. She was brought to the operating room for definitive
DESCRIPTION OF OPERATION:
made midline in line with the patient's previous skin incision. Carefully
dissected subcutaneous flaps. The patient basically, the patellar tendon
avulsed off the inferior pole of the patella. There was just a small thumb
nail size remnant but complete disruption of the extensor mechanism. There was
also disruption of her retinaculum which had sort of retracted towards the
midline posteriorly. The arthroplasty components were still well-fixed,
especially the patellar component. We spent a lot of time carefully dissecting
the tissue plane which was difficult at times. We mobilized the quad with
finger and sharp dissection to break up adhesions. This allowed us to pull the
patella distally nicely. We then used #2 FiberWire in a locking baseball type
stitch through the patellar tendon remnant. This was done with 2 sutures.
Drill holes were made in the patella and then these sutures passed through the
drill holes. Tension was placed on the patella remnant and it was pulled
distally as the sutures were tied, giving us a nice repair directly to bone.
We had earlier freshened up the bone along the patella where the repair
inserted. Again, we had already assessed the patellar polyethylene and that
was stable. Next, we further repaired as best we could the retinacular tears.
We were able to reapproximate the arthrotomy. All this was done with 0 Vicryl.
Many sutures were placed in order to get as good of a repair and soft tissue
mass as possible. The knee was irrigated throughout the procedure.