We were able to start with the inferolateral portal, made with the sharp #15 blade knife, just about a cm above the joint line, and lateral to the patellar tendon in a vertical fashion, less than a cm long. I used a blunt trocar and cannula to enter the joint, and then up into the suprapatellar pouch region, where I removed the trocar and inserted the camera. The diagnostic arthroscopy revealed that there was significant synovial tissue in the suprapatellar pouch region that was red and angry appearing, with small crystals noted throughout the synovial tissues. There were multiple areas of small cartilage debris in the medial and lateral gutters that required suction removal through the shaver as well. I did remove some of the synovium in the suprapatellar pouch region as well.
I moved down into the medial compartment, where I was able to make an inferomedial portal in a horizontal fashion using an 18 gauge to gain trajectory, and then finally a #15 blade to gain entry into the knee. I used a probe to go into the suprapatellar pouch region and confirm that there was grade 1 chondromalacia of the patellofemoral joint. No shaving or debriding was required, with no evidence of loose flaps or tears appreciated.
Medicare Patient
29881 lt
29875 59 lt
The medial compartment actually was also unremarkable in the fact that there was no evidence of cartilage lesions, with intact medial femoral condyle, and only grade 1 changes, with no flaps, tears, or fissures of the medial plateau. The medial meniscus was also probed to be intact on the peripheral rim from the undersurface and superior portion. Again, the crystals were found throughout the medial compartment as well. The ACL was noted to be intact on probing, but there was some fraying and some stretching to its appearance. The lateral femoral condyle had the most severe changes, with grade 3 and 4 changes, specifically of the weightbearing portion of the lateral femoral condyle, with kissing lesions also noted of the lateral tibial plateau. The lateral meniscus had a large anterior horn tear from the root attachment anteriorly around to the lateral edge. This required a combination of biters and shavers to help to remove this extra material back to a stable peripheral rim with tapered edges.
I moved down into the medial compartment, where I was able to make an inferomedial portal in a horizontal fashion using an 18 gauge to gain trajectory, and then finally a #15 blade to gain entry into the knee. I used a probe to go into the suprapatellar pouch region and confirm that there was grade 1 chondromalacia of the patellofemoral joint. No shaving or debriding was required, with no evidence of loose flaps or tears appreciated.
Medicare Patient
29881 lt
29875 59 lt
The medial compartment actually was also unremarkable in the fact that there was no evidence of cartilage lesions, with intact medial femoral condyle, and only grade 1 changes, with no flaps, tears, or fissures of the medial plateau. The medial meniscus was also probed to be intact on the peripheral rim from the undersurface and superior portion. Again, the crystals were found throughout the medial compartment as well. The ACL was noted to be intact on probing, but there was some fraying and some stretching to its appearance. The lateral femoral condyle had the most severe changes, with grade 3 and 4 changes, specifically of the weightbearing portion of the lateral femoral condyle, with kissing lesions also noted of the lateral tibial plateau. The lateral meniscus had a large anterior horn tear from the root attachment anteriorly around to the lateral edge. This required a combination of biters and shavers to help to remove this extra material back to a stable peripheral rim with tapered edges.
