PREOPERATIVE DIAGNOSIS:
Left Medial meniscus tear.
POSTOPERATIVE DIAGNOSIS:
Same
PROCEDURES:
1. Arthroscopic Left partial Medial meniscectomy. (29881)
2. Arthroscopic cyst removal off anterolateral ACL (29875)
SURGEON:
.
ASSISTANT:
PA was crucial for the entirety of the procedure.
There was no qualified resident available.
ANESTHESIA:
General.
ESTIMATED BLOOD LOSS:
25cc
IV FLUIDS:
500cc
INDICATIONS FOR PROCEDURE:
is a 45 y.o. male with left knee pain for 1 month
without specific injury. He is active duty in a military at
He has a history of a left knee arthroscopy in
2008. He reports anterior medial and anterolateral pain as
well as posterior pain. He reports his posterior pain is
worse after running. He also describes it as shooting in
nature. 3 weeks ago, he got a steroid injection that helped a
little. He had an MRI that showed a Medial meniscus tear. He was advised the risks and benefits of operative versus nonoperative treatment. He understood those risks and benefits and agreed to proceed with surgery today.
DESCRIPTION OF PROCEDURE:
He was brought to the operating room, placed supine on the OR
table, underwent general anesthesia without difficulty. Preop time-out was
done identifying his Left knee as the operative knee. He was given preoperative antibiotics in the holding area.
His examination under anesthesia revealed a stable Lachman, stable to varus
and valgus stress, stable anterior and posterior drawer.
He was placed in nonsterile tourniquet and prepped and draped in sterile fashion using ChloraPrep. His limb was elevated, exsanguinated and tourniquet was raised.
Standard diagnostic arthroscopy was begun using anteromedial and anterolateral portals with the following findings:
There was grade 1 chondromalacia on his patella. He had no chondromalacia involving the trochlea. The medial joint had grade 1 chondromalacia on the medial femoral condyle and grade 1 chondromalacia on the medial tibial plateau. The meniscus was torn with a complex tear involving the body and posterior horn. This encompassed approximately 75% of the meniscal width and it was intact to probing after debridement with a meniscal biter and shaver. The intercondylar notch revealed an intact ACL and PCL, there was a cyst along the anterolateral ACL and synovium that was debrided back to stable rim using an oscillating shaver. The lateral joint had no chondromalacia on the lateral
femoral condyle and no chondromalacia on the lateral tibial plateau. The meniscus was not torn. We examined the medial and lateral gutter for any further
Pathology or loose bodies. There was none. We then removed the arthroscopic tools from the joint, closed both portals using interrupted 3-0 nylon stitches in a
simple fashion. Both portals were injected with 0.5% ropivacaine without
epinephrine. Xeroform, dressing sponges, two ABDs, Webril, and an Ace wrap were
applied. The patient tolerated the procedure well and was transferred to
recovery room in stable condition.
Postoperatively, can be weightbearing as tolerated on his Left lower extremity. We will see him back in 10-14 days for repeat evaluation and suture removal. He can start physical therapy in 1-3 days on my partial meniscectomy protocol.
Left Medial meniscus tear.
POSTOPERATIVE DIAGNOSIS:
Same
PROCEDURES:
1. Arthroscopic Left partial Medial meniscectomy. (29881)
2. Arthroscopic cyst removal off anterolateral ACL (29875)
SURGEON:
.
ASSISTANT:
PA was crucial for the entirety of the procedure.
There was no qualified resident available.
ANESTHESIA:
General.
ESTIMATED BLOOD LOSS:
25cc
IV FLUIDS:
500cc
INDICATIONS FOR PROCEDURE:
is a 45 y.o. male with left knee pain for 1 month
without specific injury. He is active duty in a military at
He has a history of a left knee arthroscopy in
2008. He reports anterior medial and anterolateral pain as
well as posterior pain. He reports his posterior pain is
worse after running. He also describes it as shooting in
nature. 3 weeks ago, he got a steroid injection that helped a
little. He had an MRI that showed a Medial meniscus tear. He was advised the risks and benefits of operative versus nonoperative treatment. He understood those risks and benefits and agreed to proceed with surgery today.
DESCRIPTION OF PROCEDURE:
He was brought to the operating room, placed supine on the OR
table, underwent general anesthesia without difficulty. Preop time-out was
done identifying his Left knee as the operative knee. He was given preoperative antibiotics in the holding area.
His examination under anesthesia revealed a stable Lachman, stable to varus
and valgus stress, stable anterior and posterior drawer.
He was placed in nonsterile tourniquet and prepped and draped in sterile fashion using ChloraPrep. His limb was elevated, exsanguinated and tourniquet was raised.
Standard diagnostic arthroscopy was begun using anteromedial and anterolateral portals with the following findings:
There was grade 1 chondromalacia on his patella. He had no chondromalacia involving the trochlea. The medial joint had grade 1 chondromalacia on the medial femoral condyle and grade 1 chondromalacia on the medial tibial plateau. The meniscus was torn with a complex tear involving the body and posterior horn. This encompassed approximately 75% of the meniscal width and it was intact to probing after debridement with a meniscal biter and shaver. The intercondylar notch revealed an intact ACL and PCL, there was a cyst along the anterolateral ACL and synovium that was debrided back to stable rim using an oscillating shaver. The lateral joint had no chondromalacia on the lateral
femoral condyle and no chondromalacia on the lateral tibial plateau. The meniscus was not torn. We examined the medial and lateral gutter for any further
Pathology or loose bodies. There was none. We then removed the arthroscopic tools from the joint, closed both portals using interrupted 3-0 nylon stitches in a
simple fashion. Both portals were injected with 0.5% ropivacaine without
epinephrine. Xeroform, dressing sponges, two ABDs, Webril, and an Ace wrap were
applied. The patient tolerated the procedure well and was transferred to
recovery room in stable condition.
Postoperatively, can be weightbearing as tolerated on his Left lower extremity. We will see him back in 10-14 days for repeat evaluation and suture removal. He can start physical therapy in 1-3 days on my partial meniscectomy protocol.