29851 Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; with internal or external fixation (includes arthroscopy)

Name of the Procedure:

Arthroscopically Aided Treatment of Intercondylar Spine(s) and/or Tuberosity Fracture(s) of the Knee with Internal or External Fixation (includes arthroscopy). Commonly referred to as arthroscopic knee fracture repair.

Summary

Arthroscopic knee fracture repair is a minimally invasive surgical procedure where doctors use a small camera and instruments to fix fractures within the knee joint. It facilitates accurate repair of fractures involving the intercondylar spine or tuberosity, which are crucial areas for knee stability.

Purpose

This procedure addresses fractures of the intercondylar spine and the tuberosity of the knee. The goals are to stabilize the knee joint, promote proper healing of the fracture, and restore knee function. This can help reduce pain and prevent long-term joint issues.

Indications

• Acute knee pain with confirmed fracture of the intercondylar spine or tuberosity.
• Reduced knee mobility or instability due to fracture.
• Swelling and bruising around the knee.
• Difficulty bearing weight on the affected leg.
• Young or active patients where joint stability is crucial for returning to daily activities or sports.

Preparation

• Patients are generally required to fast for 6-8 hours before the procedure.
• Temporary cessation or adjustment of certain medications, such as blood thinners.
• Pre-operative imaging tests such as X-rays or MRI to assess the extent of the fracture.
• Blood tests to ensure the patient's fitness for surgery.

Procedure Description

1. Anesthesia is administered, typically general or spinal.
2. Small incisions are made around the knee.
3. An arthroscope (a tiny camera) is inserted to provide a clear view of the knee joint.
4. Specialized instruments are used, guided by the arthroscope, to visualize and fix the fracture.
5. Internal or external fixation devices (such as screws or metal plates) are used to stabilize the fractured bone.
6. The incisions are then closed with sutures or surgical staples.

Duration

The procedure typically takes 1-2 hours, depending on the complexity of the fracture.

Setting

Performed in a hospital or surgical center, often as an outpatient procedure.

Personnel

• Orthopedic surgeon or arthroscopic specialist.
• Anesthesiologist.
• Surgical nurses and technicians.

Risks and Complications

• Infection at the surgical site.
• Blood clots (deep vein thrombosis).
• Damage to blood vessels or nerves.
• Residual instability or stiffness in the knee joint.
• Adverse reactions to anesthesia.
• Rarely, failure of the fixation device or incomplete healing of the fracture.

Benefits

• Minimally invasive with smaller incisions and quicker recovery.
• Accurate repair of complex knee fractures.
• Reduced post-operative pain and scarring.
• Improved knee stability and function.
• Quicker return to normal activities compared to open surgery.

Recovery

• Initial swelling and discomfort managed with ice, elevation, and medications.
• Weight-bearing restrictions and use of crutches for several weeks.
• Physical therapy to regain strength and mobility.
• Follow-up appointments for imaging and assessment.
• Full recovery typically spans 3-6 months, depending on fracture severity and patient adherence to rehabilitation.

Alternatives

• Non-surgical methods such as casting or bracing (may be less effective for severe fractures).
• Open reduction and internal fixation (traditional surgery with larger incisions).
• Pros of arthroscopic repair include less pain and quicker recovery; cons may include the suitability for only certain fracture types.

Patient Experience

• During the procedure, the patient is under general or spinal anesthesia and will not feel pain.
• Post-procedure, there can be swelling, discomfort, and a need for pain management.
• Adherence to physical therapy and gradual weight-bearing is essential.
• Patients should expect an initial period of restricted activity but can generally expect a return to normal function within a few months, with a commitment to follow-through care.