CPT® Code 29851

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

The CPT® Code 29851 refers to the arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, which may be performed with or without manipulation. This procedure is particularly relevant for pediatric patients, as these types of fractures are more commonly seen in children and are often referred to as tibial eminence fractures. The intercondylar spines are two bony projections located centrally on the proximal surface of the tibia, situated between the lateral and medial condyles. 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. An arthroscope, along with a cannula, is then introduced to visualize the knee joint. This allows for the evacuation of any blood or fluid present in the joint space, facilitating a clear view of the fracture. Once the fracture is identified, a small incision is made just medial to the tibial tubercle to access the fracture site. Guide pins are inserted on either side of the anterior cruciate ligament and passed through the intercondylar fracture fragment to aid in stabilization. The procedure may involve the use of a cannulated suture passer to place suture material, which is then used to reduce the fracture fragments by applying tension and securing them over a bony bridge. Alternatively, the fracture fragments may be stabilized using internal fixation methods, such as K-wires or screws, placed under arthroscopic guidance. In some cases, an external fixation device may also be utilized, either as a standalone solution or in conjunction with internal fixation techniques. Tuberosity fractures are treated similarly, employing either suture material or fixation devices to ensure proper alignment and healing of the fracture fragments.