27422 Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (eg, Campbell, Goldwaite type procedure)

Name of the Procedure:

Reconstruction of Dislocating Patella with Extensor Realignment and/or Muscle Advancement or Release (e.g., Campbell, Goldwaith type procedure)

Summary

This surgical procedure involves realigning the patella (kneecap) to a more stable position and adjusting the surrounding muscles and tendons to prevent it from dislocating. It may involve tightening or loosening certain muscles and tendons around the knee.

Purpose

The procedure addresses the issue of a dislocating patella, which can cause pain, instability, and difficulty in moving the knee. The primary goal is to stabilize the patella, restore normal knee function, and alleviate discomfort.

Indications

• Frequent patellar dislocations
• Chronic knee pain and instability
• Failure of conservative treatments like physical therapy and bracing
• Recurrent knee injuries due to patellar dislocation

Preparation

• Patients may need to fast for at least 8 hours before the procedure.
• Adjustments to current medications as advised by the physician.
• Preoperative imaging tests such as X-rays or MRI to evaluate the knee's condition.

Procedure Description

1. Anesthesia is administered, typically general or regional.
2. An incision is made near the knee to expose the patella and surrounding structures.
3. The surgeon realigns the patella by tightening or releasing the muscles and tendons around it.
4. The extensor mechanism is adjusted to ensure stability.
5. Internal sutures or screws may be used to secure the new alignment.
6. The incision is closed with sutures or staples, and a bandage is applied.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a hospital or surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical assistants

Risks and Complications

Common risks:

• Infection
• Bleeding
• Swelling and stiffness

Rare risks:

• Deep vein thrombosis (DVT)
• Nerve damage
• Failure to stabilize the patella

Management of complications includes antibiotics for infection, pain medications, and physical therapy.

Benefits

• Stabilization of the patella
• Reduction in pain and discomfort
• Improved knee function and mobility
• Lower risk of future dislocations
• Benefits are usually realized within a few weeks to months post-surgery.

Recovery

• Initial rest and elevation of the knee.
• Use of crutches or a brace to avoid putting weight on the knee.
• Physical therapy to restore movement and strength.
• Full recovery can take several months, with gradual return to activities.

Alternatives

• Conservative treatments such as physical therapy, bracing, and anti-inflammatory medications.
• Less invasive surgeries like arthroscopic realignment.
• Pros and cons: Conservative treatment poses less risk but may not be as effective in severe cases; less invasive surgeries have shorter recovery times but may not provide long-term stability.

Patient Experience

• Patients may experience pain and swelling immediately after the procedure, managed by pain medication.
• Discomfort from the incision site and limited mobility.
• Gradual improvement in knee stability and function with adherence to recovery protocols.