CPT® Code 29850

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

The CPT® Code 29850 refers to the arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, which may occur with or without manipulation and does not involve internal or external fixation. This procedure is particularly relevant for treating fractures that typically affect children, often referred to as tibial eminence fractures. The intercondylar spines are anatomical structures located at the center of the proximal tibia, situated between the lateral and medial condyles, and play a crucial role in knee stability. The tibial tuberosity, on the other hand, is a prominent bony projection on the anterior aspect of the proximal tibia, serving as the attachment point for the patellar ligament. During the procedure, the physician makes portal incisions over the anterior knee joint, specifically at the medial and lateral sides, to access the joint space. An arthroscope, which is a specialized instrument equipped with a camera, along with a cannula, is introduced to visualize the knee joint. This allows for the evacuation of any blood or fluid present in the joint, facilitating a clear view of the fracture. Once the fracture is identified, a small incision is made near the tibial tubercle to facilitate the repair process. Guide pins are strategically placed on either side of the anterior cruciate ligament and passed through the intercondylar fracture fragment to aid in stabilization. The procedure involves the use of a cannulated suture passer, which is inserted to place suture material that is then drawn out of the joint. By applying tension to the sutures, the physician can effectively reduce the fracture fragments, which are subsequently secured by tying the sutures over a bony bridge. This method ensures that the fracture fragments are held in place during the healing process. In contrast, the related procedure coded as 29851 involves the use of internal or external fixation methods, such as K-wires or screws, to stabilize the fracture fragments, which may also be applied in the case of tuberosity fractures. Overall, CPT® Code 29850 encompasses a minimally invasive approach to treating specific knee fractures, emphasizing the importance of arthroscopic techniques in orthopedic surgery.