CPT® Code 29866

1. Indications

The procedure described by CPT® Code 29866 is indicated for the treatment of specific conditions affecting the knee joint, particularly those involving damage to the articular cartilage. The following are the primary indications for performing this procedure:

• Chondral Defects - These are localized areas of damage to the cartilage that can lead to pain and functional impairment in the knee.
• Osteochondral Defects - This condition involves damage to both the cartilage and the underlying bone, which can significantly affect joint function and stability.
• Weight-Bearing Surface Damage - The procedure is specifically aimed at addressing defects located on the weight-bearing surfaces of the knee joint, which are critical for normal movement and load distribution.

2. Procedure

The surgical procedure for CPT® Code 29866 involves several key steps that are performed with precision to ensure effective treatment of the knee joint. The following outlines the procedural steps:

• Step 1: Arthroscopic Inspection - The procedure begins with the insertion of an arthroscope into the knee joint. This allows the surgeon to visually inspect the interior of the knee, identifying the specific areas of cartilage damage that require intervention.
• Step 2: Measurement of Damage - Once the damaged area is located, the surgeon measures the extent of the defect. This assessment is crucial for determining the number of osteochondral grafts needed for adequate repair.
• Step 3: Graft Harvesting - The surgeon then proceeds to harvest cylindrical osteochondral grafts from a nonweightbearing surface of the knee, typically the femoral trochlea or the medial or lateral walls of the intercondylar notch. A tubular chisel is utilized to carefully extract these grafts, ensuring they are of appropriate size for the defect.
• Step 4: Preparation of Recipient Site - After harvesting the grafts, a tunnel is drilled at the site of the cartilage defect. This preparation is essential for the successful insertion of the grafts.
• Step 5: Graft Insertion - The harvested grafts are then inserted into the prepared defect using a plunger. This process is repeated until the entire damaged area is filled with the autogenous grafts, ensuring comprehensive coverage of the defect.
• Step 6: Stability Testing - Following the insertion of the grafts, the surgeon tests the range of motion of the knee to confirm that the graft sites are stable and that the knee can function properly post-procedure.

3. Post-Procedure

After the completion of the procedure, the surgeon removes the arthroscope and any surgical tools used during the operation. The portal incisions made for the arthroscopy are then closed to promote healing. Post-procedure care typically involves monitoring the patient for any immediate complications and providing instructions for rehabilitation. Patients may be advised on weight-bearing restrictions and range of motion exercises to facilitate recovery. Follow-up appointments are essential to assess the healing process and the effectiveness of the grafts in restoring knee function.