PREOPERATIVE DIAGNOSIS:
Right Medial meniscus tear/loose bodies Right knee
POSTOPERATIVE DIAGNOSIS:
Same,no medial meniscus tear
PROCEDURES:
1. Arthroscopic shaving chondroplasty Right patellofemoral joint and Medial femoral condyle. (29877)
2. Arthroscopic Loose body removal x 4 from posteromedial/posterolateral knee (29874)
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:
800cc
INDICATIONS FOR PROCEDURE:
with right knee pain. This has been present off and on for years, but recently flared up after her started working with his daughter playing soccer. He has noticed some pain and instability with his right knee while walking on flat even surfaces. He occasionally has some swelling on the infero-lateral knee. He reports no catching or locking. He has no problems doing gliding movements, such as biking. 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 Right 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 4 chondromalacia on his patella that was debrided back to stable rim creating a well shouldered lesion using an oscillating shaver. He had grade 3/4 chondromalacia involving the trochlea that was debrided back to stable rim creating a well shouldered lesion using an oscillating shaver and a ring curette. The medial joint had grade 3/4 chondromalacia on the medial femoral condyle and grade 3 chondromalacia on the medial tibial plateau. The meniscus was not torn. The intercondylar notch revealed an intact ACL and PCL. The lateral joint had no chondromalacia on the lateral
femoral condyle and grade 3 chondromalacia on the lateral tibial plateau. The meniscus was not torn. We then used a drive through technique under the PCL to view the posterior knee. There were 4 loose bodies behind the PCL in the posteromedial and posterolateral knee. We made a separate incision/ posteromedial portal with a knock and spread technique in order to access the posterior knee. The loose bodies were removed with a loose body grasper. 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 Right 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.
Right Medial meniscus tear/loose bodies Right knee
POSTOPERATIVE DIAGNOSIS:
Same,no medial meniscus tear
PROCEDURES:
1. Arthroscopic shaving chondroplasty Right patellofemoral joint and Medial femoral condyle. (29877)
2. Arthroscopic Loose body removal x 4 from posteromedial/posterolateral knee (29874)
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:
800cc
INDICATIONS FOR PROCEDURE:
with right knee pain. This has been present off and on for years, but recently flared up after her started working with his daughter playing soccer. He has noticed some pain and instability with his right knee while walking on flat even surfaces. He occasionally has some swelling on the infero-lateral knee. He reports no catching or locking. He has no problems doing gliding movements, such as biking. 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 Right 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 4 chondromalacia on his patella that was debrided back to stable rim creating a well shouldered lesion using an oscillating shaver. He had grade 3/4 chondromalacia involving the trochlea that was debrided back to stable rim creating a well shouldered lesion using an oscillating shaver and a ring curette. The medial joint had grade 3/4 chondromalacia on the medial femoral condyle and grade 3 chondromalacia on the medial tibial plateau. The meniscus was not torn. The intercondylar notch revealed an intact ACL and PCL. The lateral joint had no chondromalacia on the lateral
femoral condyle and grade 3 chondromalacia on the lateral tibial plateau. The meniscus was not torn. We then used a drive through technique under the PCL to view the posterior knee. There were 4 loose bodies behind the PCL in the posteromedial and posterolateral knee. We made a separate incision/ posteromedial portal with a knock and spread technique in order to access the posterior knee. The loose bodies were removed with a loose body grasper. 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 Right 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.
