If both the ATFL and CFL are repaired in an end-to-end fashion then 27696 both collateral ligaments would be reported. endobj The UW Shoulder Site @ uwshoulder.com. The soft tissue was pulled proximally and pinched into the bed of origin. For claims with a date of service on or after October 1, 2015, use an equivalent ICD-10-CM code (or codes). The ATFL (anterior talofibular ligament) and the CFL ( calcaneofibular ligament) are ligaments of the lateral complex in the ankle. Select the procedure code that most closely reflects the actual work you primarily performed. 29828 Arthroscopy, shoulder, surgical; biceps tenodesis 10 Ways ASC Coders Can Keep Up With Coding Rules at Little or No Cost, Coding Guidance: Endoscopic Balloon Dilation of Sinuses. Because there is no category ICPT code that describes the procedure using allograft, we must report theservice using code 27899 (unlisted procedure, leg or ankle). jU 10]dtL&D$j3x }JdLFDXGCLrJACDRQA&0@;+R..*&djHRRf`VG0W~?q{YTTLN'b|C[9Y?|WVnI:KGb}X s>J[>R..zi+U^qC%N_4)La)@KeTZfsTt.h A gap of over 4 mm with medial ankle pain over the deltoid ligament suggests a disruption of the deltoid ligament. JavaScript is disabled. Coding Guides (28) 2023 Coding and Reimbursement Guide for the NanoScope Operative Arthroscopy System File Type: Ref. Discover how to save hours each week. A physician may perform a direct repair to the ligament(s) (primary) and supplement or reinforce that repair by transferring the extensor retinaculum up over the ligament(s) in what's called a Gould modification. Learn how to get the most out of your subscription. <> After an incision was made along the lateral aspect of the elbow, the center axis of rotation was confirmed and holes were pre-drilled for the insertion of the InternalBrace system with placement of LabralTape and a FiberWire suture. Without seeing the operative note, and addressing only your question, the correct code is CPT code 27698. Editor's Note: This article by Paul Cadorette, director of education for mdStrategies, originally appeared in The Coding Advocate, mdStrategies free monthly newsletter. endobj x}kRa_?B&s706PHCl,hpX"&2RK-|)mQyNH=Y/:W_0x(%1X]qn! It has been established as a viable modality of treatment for anterior impingement and osteochondral defects. Utilizing the TightRope construct provides the benefit of cortical fixation and gives surgeons complete control of the final construct tension. If the medial clear space remains wide after fibular fixation, this may indicate that the deltoid ligament is entrapped in the medial gutter and needs to be explored more thoroughly. 1 0 obj 24345 Repair medial collateral ligament, elbow, with local tissue 24346 Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft) IHO? public use. The code 27814 is open txmt bimalleolar ankle fx, so would not be the code for the ligament repair. 3 0 obj KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. You are using an out of date browser. With these types of procedures there is no repair made to the ligament itself. Protocols for Coding Tear and Rupture Injuries in BWC's System. {zFryNFxlxM A zR+*20nd\H> r-\ '=~G5g'?\R:R&H A=MHJeR2>9vmBo^9LCR&H Ag"VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju' $H/VwJ A zju'~LB.VQ{Fk{x=AUBBBBCECuCC1Ia``+^`AR.$"J}\ cDJ qAAI8:}r. >6v1[C3lH-(|( a!$2zrTXDtDF~^M.U"0&z'%J@*Qi9Q0Y%J2=DHIETtTrG"SR]BuqRW*P~mZK(VwIBGTHu^4X>KB&g*AUBBBBCECuCC1td,hYs SR:K32XG Laterally - The anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), calcaneofibular ligament (CF) are responsible for resistance against inversion and internal rotation stress. <> 4 0 obj The Deltoid Ligament Reconstruction Implant System provides a turnkey repair technique to treat this previously difficult to manage pathology using a TightRope and gold standard Bio-Tenodesis Screws. It attaches the medial malleolus to the navicular, talus and calcaneus. stream If, however, the surgery was done as a secondary injury repair (e.g., repair of chronic unstable ankle), the code would be CPT 27698 (repair, %PDF-1.4 While it is expected that fellows will report cases in each defined case category, there are no minimum case numbers required at this time. <> However, based on information received from the AMA, code selection does not take into consideration the timing of the injury, but rather, how the ligaments were repaired. It is one of many ankle ligaments that support this complex joint. SHOULDER 23030 Incision and drainage, shoulder area; deep abscess or hematoma 23031 Incision and drainage, shoulder area; infected bursa . CPT Codes. Copyright 2023 Becker's Healthcare. This ligament is important in providing anterior to posterior stability as well as preventing lateral subluxation of the talus. When a right elbow lateral collateral ligament repair with both local tissue and application of an InternalBrace is performed, is the procedure reported with CPT code 24343 or is it more appropriate to report the unlisted code, 24999, since they are using an InternalBrace . There may also be an avulsion, or pulling away of a piece of bone, from the tip of the medial malleolus. endobj Magpi, Vflap) 54324 1stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by localskin flaps (eg, flipflap, prepucial flap) A right elbow lateral collateral ligament rupture, ripped from the origin with gross instability of the lateral soft tissue, was repaired with local tissue and application of an InternalBrace. ICD-10 code S93.421A for Sprain of deltoid ligament of right ankle, initial encounter is a medical classification as listed by WHO under the range - Injury, poisoning and certain other consequences of external causes . % 1 0 obj The lateral ligaments are more commonly involved (ATFL more than CF, least PTFL). endobj endobj Often times, this treatment allows for adequate approximation of the deltoid ligament, which will then scar down and heal with time. As such, the examiner must have a high index of suspicion of this injury when examining the patient as to not be distracted by a fracture and fail to assess the deltoid ligament. If this case, if the deltoid ligament continues to demonstrate laxity, a repair may be recommended. registered for member area and forum access. <> endstream Humeral Avulsion of the Glenohumeral Ligament (HAGL) is an injury to the inferior glenohumeral ligament causing instability and/or pain and a missed cause of recurrent shoulder instability. Dr. Frederic A Matsen III and has not been proofread or intended for general ^u\i! #: OF1-000119-en-US Version: K CPT code 27698 describes the secondary repair (or reconstruction) of the collateral ligament of the ankle, while CPT code 27696 describes a primary repair of both the medial and lateral ligaments in the ankle. <> stream He presented in ER with shoulder pain and was diagnosed with . stream Secondary means other tissue is brought in to perform the repair because it's too late to do a primary repair (usually a period of time after the injury). . Tony Poggio, DPM Alameda, CA In some patients who undergo fixation of the lateral malleolus, ankle instability may persist. For a better experience, please enable JavaScript in your browser before proceeding. compilation for random notes and resources. 27427 - Ligamentous reconstruction, knee; extra-articular. Also, in high performance athletes or very active individuals, deltoid ligament repair may be indicated to facilitate a more robust fixation of the joint. |WB$$!=$N_ IHBW; |%$! :Ey7TTF]w( v]1~_>#_G>7(`_aL7hr+ib*&BJ}#|r\fCIxu+g7acKELGsA68tg0>( +?.LGD>RSRx`:`KJ%[z Answer: <> stream 2023 Jared Lee, MD. No charge. of shoulders, please visit 2 0 obj 1 0 obj C cmedina Guest Messages 28 Location Montclair, NJ Best answers 0 Feb 13, 2008 #3 endobj At that point, a second suture anchor was placed more proximally at the supracondylar ridge, holes were pre-drilled and the suture anchor was deployed. 2 0 obj Don't confuse the Gould modification with a secondary repair. Or the excision of the bone fragment, CPT 28124. You should not bill both codes. The doctor confused me initially. We are looking at CPT codes and wondering if we should be reporting CPT code 27696 or CPT code 27698. deltoid Capsuloligamentous Complex coracohumeral Ligament superior glenohumeral ligament (SGHL) middle glenohumeral ligament (MGHL) inferior glenohumeral ligament (IGHL) hammock-like Structure anterior band - between 2 and 4 o'clock posterior Band - between 7 and 9 o'clock axillary pouch 2 types of Insertion on Humerus REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE: 24346 : RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES HARVESTING OF GRAFT) A disruption to the deltoid ligament requires a significant force to the ankle when the ankle is in eversion and dorsiflexion. It typically takes place as an outpatient procedure. Surgical Technique Animations | 04:55 | English | 11/05/2015 | AN1-00134-EN A, Surgical Technique Videos | 07:24 | English | 08/26/2014 | VID1-00242-EN A, Surgical Technique Guides | English | 01/27/2022 | LT1-00002-en-US C, Product and Technique Highlights | English | 12/19/2014 | LS2-0418-EN A, 09:17 | English | 04/06/2016 | VID2-00603-EN A, 07:24 | English | 08/26/2014 | VID1-00242-EN A, 04:55 | English | 11/05/2015 | AN1-00134-EN A, 02:04 | English | 09/10/2015 | AN2-00158-EN A, 01:20 | English | 05/06/2019 | pAN1-00134-EN A. ICD-10-CM Codes. endobj This ligament is important in providing anterior to posterior stability as well as preventing lateral subluxation of the talus. endstream Non-operative first-line treatment for acute presentation includes sling immobilization and physical therapy while operative treatment is recommended for recurrent instability. The surgeon accurately reports these procedure to a private payer as 23412, 29824-51, and 29826. , , Complications of the procedure include neurological injury, vascular injury, aneurysm, and infection; however, it is a relatively low-risk procedure. Background: Patients with chronic deltoid ligament insufficiency (CDLI) present a challenging situation. Frederick A Matsen III. cjZs~A Linking and Reprinting Policy. Your surgeon will perform stress views intra-operatively to ensure reduction of the ankle mortise. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> For complimentary Telehealth tools and information, click here. View all the articles associated with any code, right from the code page. This is in contrast to the Bankart lesion in which the IGHL is disrupted from the glenoid. He kept arguing with me about using the fracture code. %PDF-1.7 % All rights reserved. DEFINED CASE CATEGORIES/CPT CODE MAPPING ELECTIVE RECONSTRUCTION FOREFOOT ELECTIVE RECONSTRUCTION MIDFOOT/HINDFOOT ARTHROSCOPY ARTHRODESIS ARTHROPLASTY TRAUMA ANKLE HINDFOOT (GENERAL) CALCANEUS TALUS PILON TRAUMA MIDFOOT/FOREFOOT (GENERAL) LISFRANC These reports will reflect only the primary CPT codes identified for each tracked case. Medial refers to the inside of your ankle. The deltoid ligament is a strong, broad, flat, triangular shaped ligament located on the medial (inside) of the ankle. Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. [dV'N'iR|nzy"['dO.0}FpOcb}_QNJ+~T*Av',B}v>>AAV Humeral avulsion of the inferior glenohumeral ligament (HAGL) has been shown to be an infrequent cause of shoulder instability. CPT Code Description 23000. S93.42. For questions on reimbursement or to find information for a specific product, please contact the Arthrex Coding and Reimbursement Hotline at 1-844-604-6359 or email us at arthrex@cmcopilot.com. AX__rFQk4$.K6;D}Smx0N Three bones make up the ankle joint. Feb. 20, 2020. . 8th Annual Becker's Health IT + Digital Health + RCM Annual Meeting. These are the tibia (shinbone), the fibula (the smaller bone in your leg), and the talus (a bone in your foot). Let's take a look at the two codes in question: 27696 Repair, primary, disrupted ligament, ankle; both collateral ligaments. Short description: SPRAIN OF ANKLE DELTOID. Ask a coder what the difference is between a primary and secondary ankle ligament repair and many will refer you back to the Coder's Desk Reference which indicates a secondary repair occurs a period of time after the initial injury and for the most part, this is true. IHBO_$$$! 3 0 obj acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure) 29827 SARTHRO Arthroscopy, shoulder, surgical; with rotator cuff repair 29828 SARTHRO Arthroscopy, shoulder, surgical; biceps tenodesis Shoulder - Arthroscopy CPT Code Defined Ctgy Description X-rays often show widening of the medial clear space between the medial malleolus and talus. Secondary means other tissue is brought in to perform the repair because it's too late to do a primary repair (usually a period of time after the injury). ]PI $ |WB$SsTm@UvT7~BzR>>q.NXlHZA] $H AOSZI5\BaZ5>~rS|4)K A B+vn j%{JsL:|`>rb[JV $HjjjQEP(F*8Wdo9vpWV+;x/ek Arthritis (Total and Reverse Total shoulder). <> stream NPI Look-Up Tool (National Provider Identifier), The official publication for Level I HCPCS (CPT-4 codes) for hospital providers, Also specific Level II HCPCS codes for hospitals, physicians and other health professionals, Fully searchable through Find-A-Code's Comprehensive Search, Codes mentioned in articles are linked to Code Information pages, Code Information page link back to related articles. The information provided should be utilized for educational purposes only. Get crucial instructions for accurate ICD-10-CM S93.421A coding with all applicable Excludes 1 and Excludes 2 notes from . ICD-9-CM 845.01 is a billable medical code that can be used to indicate a diagnosis on a reimbursement claim, however, 845.01 should only be used for claims with a date of service on or before September 30, 2015. *.##x8DDZr $0 Who is the most 'overpaid' CEO in healthcare? See our privacy policy. ?[;FVov Ylkr>oxiyOWL4/KB*a+Vas})~++z*76 @-+O w`/F-G"}81;oa*aH(!g?fo2Cqsg:Ac1 3ma{qoQ9YqZcp9\5oX7GaPXi&&(,v"]CMFB{ppx%aJ"B 0H2^~9Wfw. A reconstruction would not be performed if the ligament was repairable. Sign-up to receive this newsletter by clicking here. 2021 Evaluation and Management Codes: Is a History and Exam Required? "The injured worker twisted his right shoulder while moving boxes. Privacy Policy. The new system is in place now. KKKP(Hb1,YMAz+ I still billed the 27698. Without seeing the operative note, and addressing only your question, the correct code is CPT code 27698. All Rights Reserved. Dislocation and sprain of joints and ligaments at ankle, foot and toe level (S93) Sprain of deltoid ligament (S93.42) S93.419S. It attaches the medial malleolus to the navicular, talus and calcaneus. 2021 E/M Guidelines and Consultation Codes, Two Orthopaedic Surgeons, Two Separate Surgeries, Medical Decision Making Credit for Ordering an Audiogram. Codingline Response: If the lateral ankle repair was done as a primary repair following a recent ankle injury, the correct CPT would be CPT 27695 (repair primary, disrupted ligament, ankle, collateral). 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference, 8th Annual Health IT + Digital Health + RCM Conference, 29th Annual Meeting - The Business & Operations of ASCs, Digital Innovation + Patient Experience and Marketing Virtual Event, 580+ ASCs with total joint replacements | 2023, State-by state breakdown of 2022's 183 new ASCs, 510 of America's 'Best' ASCs in 2023: Newsweek, 8 cardiologists leave Harbin Clinic for AdventHealth amid Atrium merger, OhioHealth, Surgery Partners team up to grow ASC care across the state, The advantage of PE-backed, physician-led ASCs, What physicians do when patients can't pay their bills, Surgery Partners to manage Intermountain Health ASCs, ASC Administrator of the Week: Michelle Eilander, Reimbursements remain low while costs keep climbing: 43 healthcare leaders share their biggest concerns regarding procedure reimbursements, The bargaining chip gastroenterologists are using to command higher salaries, Pennsylvania physician sentenced to up to 6 years for unlawful opioid prescription, Pennsylvania pain management physician pleads guilty to healthcare fraud, Connecticut physician fined for overprescribing narcotics, Florida physician pleads guilty to receiving kickbacks in $2.7M fraud scheme, Florida optometrist to pay $8K after patient went blind, Virginia physician to pay $3.1M to settle kickback allegations, Advanced practice registered nurse compensation: 7 facts, Patient died following plastic surgery at ASC where OB-GYN provided anesthesia, Wisconsin physician sentenced for drug crimes, Anesthesiologist accused of tampering with IV bags 'terrified' coworkers, Utah physician charged with performing surgeries without a license, Iowa clinic files for bankruptcy following $97M malpractice judgment, $15M malpractice suit brought against Virginia GI center alleging medical negligence, Physician cuts will create 'immediate financial instability': 4 thoughts on physician pay, Tufts Medical Center anesthesiologist charged with attempted child sex trafficking, USPI's $1.2B SurgCenter deal: How one of the industry's biggest acquisitions is unfolding, Physician leaders balk at Medicare 4.48% physician fee cut, Physician's license suspended in 2 states after allegedly using drugs on duty, Tennessee physician found guilty on 45 counts of controlled substance distribution, UCSD accused of ignoring anesthesiologist's fentanyl abuse, Physician pay is changing up in 8 specialties, down in 4 in 2022, Florida physician pleads guilty to receiving kickbacks, Kentucky physician, nurse practitioner sentenced for fraud, illegal controlled substance distribution, On the 'brink of financial collapse': California system CEO implores governor for funding, Why the No Surprises Act is harming anesthesiologists, Average income by experience: nurse practitioners vs. physician assistants, 13 most popular medical side gigs for physicians, 13 physician kickback suits totaling $332M+ in 2022, Florida physician involved in $60M fraud scheme forfeits license, Human trafficking among 16 charges faced by North Carolina hospital chief of staff, Top 3 hospitals for 14 specialties in 2022-23: US News. be to bill for CPT 28270 (capsulotomy; metatarssal-phalangeal joint, with or without tenorrhaphy, each joint). This convenient all-in-one implant kit includes all of the necessary implants and instrumentation to perform this procedure. The diagnosis is "ligament insufficiency". The elbow was then reduced and a horizontal stitch was placed through the origin of the lateral collateral ligament and tied off using FiberWire suture. Information was intended for internal use only and is a Below you will find a resource for finding the correct billing and coding for ankle ligament repair surgery or a Modified Brostrom: Explaining the use of 27696 or 7 and which to use for Medical and which code to use for lateral: http://www.aapc.com/memberarea/forums/showthread.php?t=71510 27698 Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure). Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions. 29888 - Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction. % If both the ATFL and CFL are repaired in an end-to-end fashion then 27696 both collateral ligaments would be reported. Injury, poisoning and certain other consequences of external causes. Cookie Policy. This lesion occurs when the inferior glenohumeral ligament avulses from the inferior humeral neck. 2 0 obj Lateral ankle ligament reconstruction is a surgical procedure to tighten and secure one or more ankle ligaments on the outside of your ankle. Thank you for your inquiry. "zuW8Y?GJ'+bZdf$fVRm,7mNQ)VU*aJfd2L&Yb\.!V*:8C8.StuD"fa_(( *This response is based on the best information available as of 09/30/21. 27698 Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure) endobj Our foot and ankle surgeon performed a reconstruction of the ATFL and the CFL ligament in the left leg for a chronic injury. Procedures like Evans, Watson-Jones and Chrisman-Snook are all considered secondary repairs because a proximal portion of the peroneus brevis is released and then passed through drill hole(s) in the fibula and navicular or calcaneal bones to reconstruct the ATFL and/or the CFL. medial (glenoid) versus lateral (humerus), 10% of recurrent anterior shoulder dislocators have HAGL, 27% of shoulder instability patients without bankart have HAGL, 18% of failed anterior stabilization have HAGL, hyperabduction and external rotation is the main mechanism, diving, Football, Basketball, Volleyball, Surfing, skiing, MVC, the primary biomechanical role of the rotator cuff is stabilizing the glenohumeral joint by compressing the humeral head against the glenoid, collar like attachment close to articular margin, V-shaped attachment close to cartilage rim with apex distal on metaphysis, anastamosis of branches of humeral sided and scapular sided vessels, lateral: Anterior humeral circumflex artery, Posterior humeral circumflex artery, medial: Suprascapular artery, Circumflex scapular arteries, watershed area anterolaterally: near humeral insertion anterior capsule 3 cm medial to intertubercular groove, close to HAGL lesion at 6'oclock position (2-7mm, overestimated on MRI by 2mm), most taught between 45 - 90 degrees abduction, anterior band of IGHL - anterior and inferior restraint, taught at 90 degrees abduction and external rotation, posterior band of IGHL- posterior and inferior restraint, taught at 90 degrees abduction and internal rotation, West Point Classification - by Bui-Mansfield, Presence of Associated Labral Pathology (Floating), severe persistent pain after instability event, posterior stress and posterior jerk tests, sulcus sign in neutral and external rotation, true AP radiographs in neutral and internal rotation, glenoid rim fractures, hypoplasia, fractures of humeral head, 45-degree oblique radiograph in anterior plane, fleck of bone inferior to anatomic neck - avulsion of medial cortex, normally dye appears in axillary pouch, biceps sheath, subcoracoid recess, HAGL - dye escapes inferiorly in crescent shape, consider combination with arthrogram for contraindication to MRI, Oberlander described bony HAGL lesion posterior to MGHL, recurrent instability or persistent pain after instability event, MR Arthrogram if more than 7 - 10 days from injury, coronal oblique T2 weighted fat suppressed MRI, sagittal oblique T2 weighted fat suppressed MRI, inferior pouch normally appears U - Shaped, HAGL has appearance of J - Shaped inferior pouch, chronic lesions may be difficult to see due to scar of IGHL to capsule, Anterior Bankart Tear/ Anterior Inferior Labrum tear, Posterior Bankart/ Posterior Inferior Labrum tear, first-line treatment when no instability present, 90% recurrence rate of instability with non-operative treatment, young person with primary shoulder dislocation, high recurrence rate, persistent pain or instability after missed HAGL with Bankart repair, low incidence of post-operative instability following open repair, no reported difference between open and arthroscopic repair, less soft tissue dissection compared to open, less damage to subscapularis compared to open, shoulder strengthening following sling immobilization period, visualization of neurovascular structures, subscapularis tendon released leaving a 1cm cuff, subscapularis sparing technique described by Arciero and Mazzoca, L-shaped incision lower one third subscapularis tendon, subscapularis sparing technique by Bhatia, lower border subscapularis identified by anterior humeral circumflex, pectoralis major tendon retracted inferiorly, subscapularis is usually scarred inferiorly with a HAGL, Medial humeral neck is rasped to remove scar tissue at 6 to 8 o'clock, suture anchor placed in inferior humerus necks, sutures pulled through anterior-inferior capsule, use caution, nerve is within 3mm of inferior capsule, Passive forward flexion to 90 degrees, external rotation to 30 degrees with arm at the side, Assisted active forward flexion to 140 degrees, External rotation to 40 degrees with arm at side, External rotation permitted with 45 degrees of abduction, deltoid bluntly spread in line with fibers, interval between infraspinatous and teres minor utilized, Roughen bone inferiorly on humeral neck to create bleeding surface, Place suture anchors in inferior humeral neck, Passive abduction to 45 degrees, forward flexion to 45 degrees, external rotation to 30 degrees, Internal rotation limited to arm against belly, No internal rotation with the arm abducted more than 45 degrees, anterior inferior portal above or below subscapularis, 1 cm inferior to upper border subscapularis tendon, placed in neutral position to protect musculocutaneous nerve, 7 o'clock posterior-inferior portal - Davidson and Rivenburgh, 2 - 3 cm inferior to posterior viewing portal, 3 cm inferior to lower border of posterolateral acromial angle, 2 cm lateral to standard posterior portal, humeral neck roughened with arthroscopic burr, suture anchors placed at IGHL insertion on humeral neck, suture passing device through 5 o'clock portal, horizontal mattress suture through capsular tissue to neck, suture lasso, suture anchors with curved guide, wait until all sutures are passed to tie knots, may Switch viewing portal from posterior to anterior using 30 degree scope, accessory inferior-lateral posterior portal, shaver and burr to posterior humeral neck, place 2 suture anchors into inferior humeral neck posteriorly, curved guide with all-suture anchor is helpful, use suture passer to pass sutures through posterior IGHL, tension sutures with arm externally rotated, repair IGHL 1st (before bankart) with combined injuries, Arthrofibrosis with Loss of External Rotation, Physical Therapy for external rotation stretching, Axillary nerve is 10 mm inferior to the glenoid and 2.5 mm inferior to capsule, overtightening anterior may be associated with accelerated posterior wear, Per systematic review: 0/25 operative, 9/10 nonoperative, Odds ratio 0.05 recurrence with operative vs nonoperative treatment (p=.006), Good with adequate recognition and treatment, - Humeral Avulsion Glenohumeral Ligament (HAGL), Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics, Traumatic Anterior Shoulder Instability (TUBS), Posterior Shoulder Instability & Dislocation, Multidirectional Shoulder Instability (MDI), Luxatio Erecta (Inferior Glenohumeral Joint Dislocation), Glenohumeral Internal Rotation Deficit (GIRD), Brachial Neuritis (Parsonage-Turner Syndrome), Glenohumeral Arthritis (Shoulder Arthritis), Shoulder Arthroscopy: Indications & Approach, Valgus Extension Overload (Pitcher's Elbow), Lateral Ulnar Collateral Ligament Injury (PLRI), Elbow Arthroscopy: Indications & Approach.
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