Medial Lateral Gutter Loose Bodies

A 51 year old male who has developed a floating loose joint body around his left knee.

Medial lateral gutter loose bodies.

Under these criteria for a non medicare patient a physician would report loose or foreign body removal using cpt 29874 arthroscopy knee surgical. He has had some swelling. Medial femoral condyle cartilage. Medial tibial plateau.

Anterior horn of lateral meniscus. The loose bodies can vary in size from a few millimeters such as the size of a small pill to a few centimeters the size of a quarter. Because fragments can migrate during arthroscopic procedures full inspection of all compartments including the medial and lateral gutters is required during removal of loose bodies. The popliteal hiatus should be identified in this area fig.

With knee flexed to 90 move to medial compartment. For removal of loose body or foreign body eg osteochondritis dissecans fragmentation chondral fragmentation with a primary service such as meniscectomy or meniscal repair even from within the same compartment with modifier 59 distinct procedural service to indicate the size or separate incision criteria are met. Pigmented villonodular synovitis pvns osteoarthritis or severe degenerative disease. 54 7 and a gentle milking maneuver should be performed to assess for the presence of loose bodies that may move back and forth within the popliteal hiatus.

Occasional loose joint body will catch patellofemoral joint and causes pain. Common locations of loose bodies include the lateral gutter the suprapatellar pouch the intercondylar notch and the medial gutter 2siting the inflow cannula helps by flushing the loose bodies away from these potential sites to the tip of the telescope. The fragments can lead to damage to the articular cartilage causing osteoarthritis. This has been ongoing since the end of december not associated with any traumatic event.

X ray showed a probable loose joint body in the medial gutter.