Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)
CPT4 code
Name of the Procedure:
Reconstruction of the Medial Collateral Ligament (MCL) of the Elbow with Tendon Graft
Summary
This surgical procedure involves repairing the medial collateral ligament (MCL) of the elbow using a tendon graft, which is harvested from the patient's own body. The graft is used to replace the damaged ligament, restoring stability and function to the elbow.
Purpose
The procedure is primarily intended to address injuries to the MCL, which often occur in athletes and people who engage in activities involving repetitive stress on the elbow. The goal is to restore strength and stability to the elbow joint, allowing for a return to normal function and activity.
Indications
- Chronic elbow pain and instability
- Partial or complete tears of the MCL
- Failure of conservative treatments such as physical therapy and bracing
- Individuals whose daily activities or sports performance are significantly impaired by the injury
Preparation
- Patients may be required to fast for a specific period before the surgery.
- Adjustments in medication, especially blood thinners, may be necessary.
- Pre-operative imaging studies like MRI or X-rays to assess the extent of the damage.
- An overall health assessment, including blood tests, to ensure fitness for surgery.
Procedure Description
- Anesthesia: The procedure is typically done under general anesthesia.
- Incision: An incision is made over the medial side of the elbow to expose the damaged ligament.
- Harvesting the Graft: A tendon graft is harvested from another part of the patient's body, commonly the forearm or leg.
- Preparation of the Elbow: The damaged MCL is removed, and the elbow is prepared for the new graft.
- Graft Placement: The harvested tendon is anchored in place, either by drilling tunnels into the bone or using special fixation devices.
- Closing: The incision is closed with sutures, and a sterile dressing is applied.
- Immobilization: The elbow is often immobilized with a splint or brace to protect the reconstruction.
Duration
The procedure typically takes between 1.5 to 3 hours, depending on the complexity of the case.
Setting
Usually performed in a hospital or specialized surgical center.
Personnel
- Orthopedic surgeon specializing in elbow injuries
- Anesthesiologist
- Surgical nurses
- Possibly a surgical assistant
Risks and Complications
- Infection at the surgical site
- Nerve or blood vessel damage
- Graft failure or rejection
- Stiffness or reduced range of motion in the elbow
- Pain and swelling during recovery
Benefits
- Improved stability and strength of the elbow
- Reduction or elimination of pain
- Return to normal activities and sports
- Long-term durability of the repair
Recovery
- Initial immobilization with a brace or splint for a few weeks.
- Gradual physical therapy to regain strength and flexibility.
- Avoiding heavy lifting and strenuous activities for several months.
- Regular follow-up appointments to monitor healing.
Alternatives
- Non-surgical treatments: physical therapy, bracing, anti-inflammatory medications.
- Other surgical options: primary repair without a graft or arthroscopic procedures.
- Each alternative has its pros and cons, particularly concerning recovery time and long-term outcomes.
Patient Experience
- During the procedure: The patient will be under anesthesia and should not feel any pain.
- Immediately after: Some pain and swelling are expected, managed with pain medications.
- Recovery phase: A period of rehabilitation with possible discomfort but generally improvements in stability and function over time.