CPT® Code 29886

1. Indications

The procedure described by CPT® Code 29886 is indicated for the treatment of an intact osteochondritis dissecans lesion in the knee. This condition may present with the following symptoms or conditions:

• Joint Pain: Patients may experience localized pain in the knee joint, particularly during activities that involve weight-bearing or movement.
• Swelling: Inflammation and swelling around the knee joint may occur due to the presence of the osteochondritis dissecans lesion.
• Limited Range of Motion: The condition can lead to stiffness and a reduced ability to fully extend or flex the knee.
• Locking or Catching Sensation: Patients may report a sensation of the knee locking or catching, which can be attributed to loose bodies formed by the dissecans fragment.

2. Procedure

The surgical procedure for CPT® Code 29886 involves several key steps to effectively treat the intact osteochondritis dissecans lesion:

• Step 1: The procedure begins with the patient positioned appropriately, and anesthesia is administered to ensure comfort during the surgery. The surgeon makes portal incisions medially and laterally over the knee joint to access the area of interest.
• Step 2: An arthroscope is introduced through one of the portals, allowing the surgeon to visualize the internal structures of the knee joint. A cannula is then inserted through a second portal to facilitate the introduction of instruments and the flushing of the joint.
• Step 3: The knee joint is flushed with saline solution to clear any debris and provide a clear view of the joint's interior. The surgeon examines the joint for signs of disease, injury, or infection, and locates the dissecans fragment.
• Step 4: The base of the osteochondritis dissecans lesion is debrided as necessary to prepare it for drilling. This step ensures that the area is clean and ready for the subsequent drilling procedure.
• Step 5: Multiple small drill holes are created through the articular cartilage, extending into the diseased or necrotic bone and reaching the normal bone beneath. This drilling process creates tunnels that allow blood vessels to infiltrate the area, promoting healing by facilitating the replacement of dead bone with living tissue.
• Step 6: If the osteochondritis dissecans lesion is large or has become chronic, the surgeon may opt to place bone grafts into the drill holes. Typically, these grafts are harvested from the proximal tibia and packed into the drilled areas to support healing.
• Step 7: Internal fixation may be utilized, either alone or in conjunction with bone grafting, to compress and stabilize the dissecans fragment, ensuring proper alignment and healing.
• Step 8: After the necessary interventions, the knee is flushed again with saline solution to remove any remaining debris, and the joint is re-inspected to confirm the success of the procedure.
• Step 9: Finally, the arthroscope, cannula, and any other instruments are removed, and the portal incisions are closed to complete the procedure.

3. Post-Procedure

Following the completion of the arthroscopy for drilling of the intact osteochondritis dissecans lesion, patients can expect a recovery period that may involve rest, elevation of the knee, and the application of ice to reduce swelling. Physical therapy may be recommended to restore strength and range of motion in the knee joint. The surgeon will provide specific post-operative care instructions, including guidelines for weight-bearing activities and any necessary follow-up appointments to monitor healing and assess the success of the procedure. It is essential for patients to adhere to these instructions to ensure optimal recovery and minimize the risk of complications.