Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion
CPT4 code
Name of the Procedure:
Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans (OCD) lesion.
Summary
Arthroscopic drilling for an intact osteochondritis dissecans lesion is a minimally invasive surgical procedure performed on the knee. Using a small camera and instruments, the surgeon drills tiny holes in the bone beneath the affected cartilage to stimulate healing.
Purpose
This procedure addresses osteochondritis dissecans, which is a condition where a piece of cartilage, along with its underlying bone, detaches from the end of a bone due to poor blood supply. The goal is to enhance blood flow to the affected area and promote natural healing of the cartilage.
Indications
- Persistent knee pain and swelling
- Loose fragments within the joint
- Limited knee mobility
- Patients typically include young, active individuals or athletes experiencing these symptoms.
Preparation
- Patients may be required to fast for several hours before the procedure.
- Adjustments in medications, especially blood thinners, might be necessary.
- Preoperative imaging tests like MRI or X-rays to evaluate the lesion.
Procedure Description
- The patient is placed under general or regional anesthesia.
- Small incisions are made around the knee to insert an arthroscope (a small camera) and surgical instruments.
- The surgeon visualizes the knee joint on a monitor.
- Tiny holes are drilled into the bone beneath the intact OCD lesion to allow blood and bone marrow cells to reach the area and promote cartilage repair.
- The instruments are removed, and the incisions are closed with sutures or surgical tape.
Duration
The procedure typically takes about 1 to 2 hours.
Setting
The procedure is usually performed in a hospital or an outpatient surgical center.
Personnel
- Orthopedic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection
- Bleeding
- Blood clots
- Damage to surrounding tissues or nerves
- Persistent pain or stiffness
- Incomplete healing or need for additional surgery
Benefits
- Relief of knee pain
- Improved knee function and range of motion
- Potential to return to normal activities or sports
- Initial benefits may be observed within a few weeks, with full recovery taking several months.
Recovery
- Post-operative care includes rest, ice application, compression, and elevation (RICE).
- Pain management with medications prescribed by the doctor.
- Physical therapy is often recommended to restore strength and mobility.
- Weight-bearing restrictions may apply initially, depending on the surgeon’s advice.
- Follow-up appointments to monitor healing progress.
Alternatives
- Non-surgical options like physical therapy, bracing, and activity modification.
- Medications for pain and inflammation.
- Other surgical options such as microfracture or mosaicplasty.
- Pros: Non-surgical methods have fewer risks.
- Cons: Might be less effective for severe cases compared to arthroscopic drilling.
Patient Experience
During the procedure, the patient is under anesthesia and will not feel pain. Post-operative discomfort is managed with pain relief medications. Soreness, swelling, and bruising around the knee are common but usually improve in a few days. Full recovery might involve several months of physical therapy and restricted activities to ensure proper healing.