CPT® Code 29868

1. Indications

The procedure described by CPT® Code 29868 is indicated for patients who have experienced significant meniscal damage or loss, which may result from trauma, degenerative conditions, or previous surgical interventions. The following conditions may warrant a meniscal transplantation:

• Meniscal Tear A severe tear of the meniscus that cannot be repaired or has resulted in the complete loss of the meniscal tissue.
• Meniscal Deficiency A condition where the meniscus is absent or significantly compromised, leading to knee instability and pain.
• Degenerative Joint Disease Patients with osteoarthritis or other degenerative conditions affecting the meniscus may benefit from transplantation to improve joint function.

2. Procedure

The procedure for meniscal transplantation as outlined in CPT® Code 29868 involves several critical steps to ensure successful graft placement and knee function restoration. The following procedural steps are typically performed:

• Step 1: Arthroscopic Inspection The surgeon begins by inserting an arthroscope into the knee joint through small incisions. This allows for a clear view of the internal structures of the knee, enabling the identification of any meniscal remnants and assessment of the overall joint condition.
• Step 2: Removal of Meniscal Remnants Any remaining meniscal tissue is carefully excised to prepare the knee for the transplantation. This step is crucial to ensure that the graft can be securely placed in a clean and prepared site.
• Step 3: Preparation of the Meniscal Bed The area where the graft will be placed, known as the meniscal bed, is meticulously prepared. This may involve smoothing the bone surfaces and creating a suitable environment for the graft to adhere.
• Step 4: Creation of Bone Tunnels or Troughs If a medial meniscal transplant is being performed, two tibial bone tunnels are created to facilitate the secure placement of the graft. For a lateral meniscal transplant, a tibial trough is formed instead, which is essential for proper graft positioning.
• Step 5: Graft Configuration The allograft is then shaped and configured to fit precisely into the prepared transplant site, ensuring optimal contact and stability.
• Step 6: Mini-Arthrotomy A mini-arthrotomy is performed to allow for the introduction of the meniscal allograft into the knee joint. This small surgical opening is critical for the accurate placement of the graft.
• Step 7: Graft Positioning The meniscal allograft is positioned at the transplant site, ensuring that it aligns correctly with the surrounding structures.
• Step 8: Suturing the Graft The graft is then sutured arthroscopically to the meniscocapsular junction, securing it in place and ensuring stability within the knee joint.
• Step 9: Closure of Incisions Upon completion of the procedure, the arthroscope and surgical tools are removed, and the portal incisions are closed, concluding the surgical intervention.

3. Post-Procedure

After the meniscal transplantation procedure, patients typically undergo a recovery period that may involve physical therapy to restore knee function and strength. Post-operative care includes monitoring for any signs of complications, such as infection or graft failure. Patients are often advised to follow specific rehabilitation protocols to gradually increase mobility and weight-bearing activities. The expected recovery time can vary based on individual factors, but adherence to post-operative instructions is crucial for optimal outcomes.