29892 Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy)

Name of the Procedure:

Arthroscopically Aided Repair of Large Osteochondritis Dissecans Lesion, Talar Dome Fracture, or Tibial Plafond Fracture, with or without Internal Fixation (includes arthroscopy)

Summary

This minimally invasive surgical procedure uses an arthroscope to diagnose and treat significant cartilage and bone injuries in the ankle, such as osteochondritis dissecans (OCD) lesions, talar dome fractures, or tibial plafond fractures. The surgeon may also employ internal fixation techniques to stabilize the injury.

Purpose

The procedure aims to:

• Address cartilage and bone injuries in the ankle.
• Alleviate pain and improve joint function.
• Restore normal anatomy and prevent future joint damage.

Indications

• Persistent pain and swelling in the ankle.
• Limited joint mobility.
• Evidence of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture on imaging studies.
• Failure of conservative treatments like physical therapy.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustments to certain medications as directed by the physician.
• Preoperative imaging studies (X-rays, MRI, or CT scans).

Procedure Description

1. The patient is placed under general or regional anesthesia.
2. Small incisions are made around the ankle.
3. An arthroscope (a small camera) is inserted to visualize the joint interior.
4. Specialized instruments are used to repair the cartilage and bone injuries.
5. Internal fixation devices like screws or pins may be used to stabilize fractures.
6. The incisions are closed, and a sterile dressing is applied.

Duration

The procedure generally takes between 1 to 2 hours, depending on the complexity of the injury.

Setting

The procedure is typically performed in a hospital or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection at the surgery site
• Blood clots
• Nerve damage
• Persistent pain or stiffness
• Need for additional surgeries

Benefits

• Pain relief and improved ankle function.
• Faster recovery compared to open surgery.
• Lower risk of infection and complications due to minimally invasive nature.

Recovery

• Application of ice and elevation of the ankle.
• Limited weight-bearing with crutches or a walker for several weeks.
• Physical therapy to regain strength and mobility.
• Follow-up appointments to monitor healing.

Alternatives

• Conservative treatments (bracing, physical therapy).
• Open surgical repair.
• Long-term pain management strategies.

Patient Experience

• Mild to moderate pain and swelling post-procedure, managed with pain medications.
• Temporary immobility and need for crutches or a walker.
• Gradual return to normal activities over several weeks to months, depending on the injury and response to therapy.