PREOPERATIVE DIAGNOSES:
Right knee pain, synovitis, possible meniscal tears.
POSTOPERATIVE DIAGNOSES:
Right knee pain, synovitis involvement of the suprapatellar
area, medial joint and the anterior joint, chondromalacia of
the patellofemoral joint and the lateral tibial plateau, tears
of the posterior half of the medial meniscus and the anterior
and posterior aspects of the lateral meniscus and an inflamed
medial plica of the right knee.
PROCEDURE:
Arthroscopic examination, synovectomy of superior joint,
anterior joint and excision of the medial plica, abrasion
chondroplasty of the patellofemoral joint and lateral tibia
with partial medial and lateral meniscectomies.
SURGEON:
.
ANESTHESIA:
General LMA.
ESTIMATED BLOOD LOSS:
Minimal.
BRIEF CLINICAL HISTORY:
This is a 73-year-old white female with history of persistent
pain and soreness of her right knee. She had mild arthritis
and MRI scan showed possible meniscal tears. Options of
conservative care versus surgery were discussed with her at
length. She requested surgical treatment.
DESCRIPTION OF PROCEDURE:
After taking informed consent, the patient was brought to the
operating room and placed on the operating room table in the
supine position. After administration of general LMA
anesthesia, the tourniquet was placed in right proximal thigh.
Next, the skin was prepped and 0.5% lidocaine with
epinephrine was placed into the knee joint. The right leg was
sterilely prepped and draped in a routine manner. Time-out
was then performed. The patient was identified, and the
appropriate body site had been marked and she received
appropriate antibiotics. Next, an anterolateral arthroscopy
portal was then made.
Examination of the suprapatellar *** inflammation of
synovium, there was also a band of tissue noted superiorly.
The patellofemoral joint with some chondromalacia of the
patella was fraying, grade I to II. The medial joint showed a
thickened inflamed medial plica on the medial gutter. The
medial joint showed inflammation of the synovium and some
synovial impingement. Next, the meniscal was examined. There
is no obvious tear in the posterior half of the medial
meniscus on the insight edge. An anteromedial portal was made
and this was probed and again the tear was noted. Next, with
the aid of punch and shaver, the meniscal tear was debrided
back to stable edges. Remaining portions were probed and
noted to be stable. The notch area was examined and the ACL
and PCL were intact as was the ligament of mucosum. There was
inflamed synovium noted here also. The lateral compartment
showed inflammation with chondromalacia grade II of the tibial
plateau with tears of the posterior and anterior aspect of the
lateral meniscus. Next, with the aid of a punch and shaver,
the meniscal tears were debrided back to stable edges.
Abrasion chondroplasty was done on the tibial surface. The
remaining portions of meniscus was probed and noted to be
stable. Next, synovectomy was performed in the anterior
compartment, the plica was excised medially and band of tissue
and inflamed synovium superiorly was debrided. An abrasion
chondroplasty was also done on the patellofemoral joint back
to stable cartilage. The scope was placed in an anteromedial
portal and the shaver and anterolateral portals to complete
the debridement. The remainder of the exam was otherwise
unremarkable. The lateral gutter showed just some mild
inflammation. In the posterior aspect of the joint was also
examined to the notch and no loose bodies were noted there.
Next, the arthroscopy equipment was removed from the knee
joint. Steri-Strips used to approximate the skin edges. The
portals and joint were infiltrated with 1% lidocaine and a
sterile dressing was applied. She was transferred to the
recovery in stable condition.
Right knee pain, synovitis, possible meniscal tears.
POSTOPERATIVE DIAGNOSES:
Right knee pain, synovitis involvement of the suprapatellar
area, medial joint and the anterior joint, chondromalacia of
the patellofemoral joint and the lateral tibial plateau, tears
of the posterior half of the medial meniscus and the anterior
and posterior aspects of the lateral meniscus and an inflamed
medial plica of the right knee.
PROCEDURE:
Arthroscopic examination, synovectomy of superior joint,
anterior joint and excision of the medial plica, abrasion
chondroplasty of the patellofemoral joint and lateral tibia
with partial medial and lateral meniscectomies.
SURGEON:
.
ANESTHESIA:
General LMA.
ESTIMATED BLOOD LOSS:
Minimal.
BRIEF CLINICAL HISTORY:
This is a 73-year-old white female with history of persistent
pain and soreness of her right knee. She had mild arthritis
and MRI scan showed possible meniscal tears. Options of
conservative care versus surgery were discussed with her at
length. She requested surgical treatment.
DESCRIPTION OF PROCEDURE:
After taking informed consent, the patient was brought to the
operating room and placed on the operating room table in the
supine position. After administration of general LMA
anesthesia, the tourniquet was placed in right proximal thigh.
Next, the skin was prepped and 0.5% lidocaine with
epinephrine was placed into the knee joint. The right leg was
sterilely prepped and draped in a routine manner. Time-out
was then performed. The patient was identified, and the
appropriate body site had been marked and she received
appropriate antibiotics. Next, an anterolateral arthroscopy
portal was then made.
Examination of the suprapatellar *** inflammation of
synovium, there was also a band of tissue noted superiorly.
The patellofemoral joint with some chondromalacia of the
patella was fraying, grade I to II. The medial joint showed a
thickened inflamed medial plica on the medial gutter. The
medial joint showed inflammation of the synovium and some
synovial impingement. Next, the meniscal was examined. There
is no obvious tear in the posterior half of the medial
meniscus on the insight edge. An anteromedial portal was made
and this was probed and again the tear was noted. Next, with
the aid of punch and shaver, the meniscal tear was debrided
back to stable edges. Remaining portions were probed and
noted to be stable. The notch area was examined and the ACL
and PCL were intact as was the ligament of mucosum. There was
inflamed synovium noted here also. The lateral compartment
showed inflammation with chondromalacia grade II of the tibial
plateau with tears of the posterior and anterior aspect of the
lateral meniscus. Next, with the aid of a punch and shaver,
the meniscal tears were debrided back to stable edges.
Abrasion chondroplasty was done on the tibial surface. The
remaining portions of meniscus was probed and noted to be
stable. Next, synovectomy was performed in the anterior
compartment, the plica was excised medially and band of tissue
and inflamed synovium superiorly was debrided. An abrasion
chondroplasty was also done on the patellofemoral joint back
to stable cartilage. The scope was placed in an anteromedial
portal and the shaver and anterolateral portals to complete
the debridement. The remainder of the exam was otherwise
unremarkable. The lateral gutter showed just some mild
inflammation. In the posterior aspect of the joint was also
examined to the notch and no loose bodies were noted there.
Next, the arthroscopy equipment was removed from the knee
joint. Steri-Strips used to approximate the skin edges. The
portals and joint were infiltrated with 1% lidocaine and a
sterile dressing was applied. She was transferred to the
recovery in stable condition.
