trose45116
Expert
Posterolateral corner avulsion with articular surface defect.
Possible loose body, right knee.
Meniscal tear.
POSTOPERATIVE DIAGNOSES: Posterolateral corner avulsion with articular surface defect.
Possible loose body, right knee.
Meniscal tear.
PROCEDURES: Arthroscopic loose body removal.
Mini-open repair posterolateral corner and ligaments in knee.
Repair of the meniscus, right knee.
ANESTHESIA: General.
COMPLICATIONS: None.
ANTIBIOTICS: Ancef 1 gram.
INDICATIONS: This is a 14-year-old white female who, two weeks ago, suffered a twisting injury to her knee while on a turf field. Developed a large effusion. MRI and x-rays were performed and there appeared to be a defect of the lateral articular surface, or possibly avulsion of the posterolateral corner. The MRI intraoperative findings confirmed this with a loose body consisting of ___________ the distal lateral femoral condyle and a very small portion of the intra-articular surface. There was a loose body present with very little articular bone on it.
DESCRIPTION OF PROCEDURE: Patient brought to the operating room in supine position. General anesthesia was administered. One gram of Ancef given preoperatively. The pneumatic tourniquet applied to proximal aspect of right thigh. Preoperative examination showed no instability in full extension. There was slight valgus instability with 30 degrees flexion and a varus stress. There was also, with internal rotation, slight anterior translation. Pivot shift was negative. Following this, the knee was prepped and draped in sterile fashion. Superolateral inflow portal established. Inferolateral portal established, 30-degree scope inserted. Diagnostic portion of examination carried out. Immediately we noted about 30-40 mL of bright red blood. We went ahead and copiously irrigated the knee, with the scope inserted through a lateral portal. We went ahead and visualized the ACL. It was intact. The articular surface was intact, as was the medial meniscus. On the lateral gutter, we noted a loose body, which was mostly articular cartilage. A very small amount of bone present on it. This was deemed to be without adequate bone for repair. It was removed through a lateral incision. We went ahead and also inspected the lateral compartment, and we had noticed clinically evidence of posterolateral corner tear. At this point, we went ahead and also noticed anterolateral meniscal tear. We went ahead and made an arthrotomy laterally. We went ahead and identified the posterolateral corner avulsion. We used a single Arthrex anchor, 5.5. We went ahead and repaired the ligament complex back to the bony attachment. We also went ahead and inserted a single non-absorbable stitch to the meniscus and repaired it to the lateral capsule. Following this, the area was copiously irrigated with normal saline. The defect on the articular surface was noted to be about quarter sized. Part of it was on the articular surface; however, most of it was on the non-articular surface laterally. At this point, the knee was copiously irrigated with normal saline, closure obtained using #0 Vicryl, 2-0 Vicryl, skin clips in the skin. Bulky dressing applied. Tourniquet deflated. A hinged knee brace applied at about 20 degrees of flexion. Patient awakened and taken to recovery room in good condition.
Possible loose body, right knee.
Meniscal tear.
POSTOPERATIVE DIAGNOSES: Posterolateral corner avulsion with articular surface defect.
Possible loose body, right knee.
Meniscal tear.
PROCEDURES: Arthroscopic loose body removal.
Mini-open repair posterolateral corner and ligaments in knee.
Repair of the meniscus, right knee.
ANESTHESIA: General.
COMPLICATIONS: None.
ANTIBIOTICS: Ancef 1 gram.
INDICATIONS: This is a 14-year-old white female who, two weeks ago, suffered a twisting injury to her knee while on a turf field. Developed a large effusion. MRI and x-rays were performed and there appeared to be a defect of the lateral articular surface, or possibly avulsion of the posterolateral corner. The MRI intraoperative findings confirmed this with a loose body consisting of ___________ the distal lateral femoral condyle and a very small portion of the intra-articular surface. There was a loose body present with very little articular bone on it.
DESCRIPTION OF PROCEDURE: Patient brought to the operating room in supine position. General anesthesia was administered. One gram of Ancef given preoperatively. The pneumatic tourniquet applied to proximal aspect of right thigh. Preoperative examination showed no instability in full extension. There was slight valgus instability with 30 degrees flexion and a varus stress. There was also, with internal rotation, slight anterior translation. Pivot shift was negative. Following this, the knee was prepped and draped in sterile fashion. Superolateral inflow portal established. Inferolateral portal established, 30-degree scope inserted. Diagnostic portion of examination carried out. Immediately we noted about 30-40 mL of bright red blood. We went ahead and copiously irrigated the knee, with the scope inserted through a lateral portal. We went ahead and visualized the ACL. It was intact. The articular surface was intact, as was the medial meniscus. On the lateral gutter, we noted a loose body, which was mostly articular cartilage. A very small amount of bone present on it. This was deemed to be without adequate bone for repair. It was removed through a lateral incision. We went ahead and also inspected the lateral compartment, and we had noticed clinically evidence of posterolateral corner tear. At this point, we went ahead and also noticed anterolateral meniscal tear. We went ahead and made an arthrotomy laterally. We went ahead and identified the posterolateral corner avulsion. We used a single Arthrex anchor, 5.5. We went ahead and repaired the ligament complex back to the bony attachment. We also went ahead and inserted a single non-absorbable stitch to the meniscus and repaired it to the lateral capsule. Following this, the area was copiously irrigated with normal saline. The defect on the articular surface was noted to be about quarter sized. Part of it was on the articular surface; however, most of it was on the non-articular surface laterally. At this point, the knee was copiously irrigated with normal saline, closure obtained using #0 Vicryl, 2-0 Vicryl, skin clips in the skin. Bulky dressing applied. Tourniquet deflated. A hinged knee brace applied at about 20 degrees of flexion. Patient awakened and taken to recovery room in good condition.
