PREOPERATIVE DIAGNOSIS:
Left Medial meniscus tear.
POSTOPERATIVE DIAGNOSIS:
Same,plus multiple loose bodies and chondromalacia
PROCEDURES:
1. Arthroscopic Left partial Medial, Lateral meniscectomy. (29881)
2. Arthroscopic shaving chondroplasty Left patellofemoral joint (29877)
3. Arthroscopic multiple loose body removal Left Knee (29874)
SURGEON:
ASSISTANT:
ANESTHESIA:
General.
ESTIMATED BLOOD LOSS:
25cc
IV FLUIDS:
700cc
INDICATIONS FOR PROCEDURE: is a 45 y.o. male well known to me from my previous
practice at for a longstanding
history of left knee pain. He has had 6 surgeries on his left
knee including ACL reconstruction with a bone-tendon-bone
allograft. He had hardware removal and then three subsequent
arthroscopies. He has had no surgery for the last 25 years.
He reports swelling, crunching and sharp anterior pain and
popping as well as instability. It hurts to sit on a toilet
without having his leg extended. He has had no physical
therapy or injections for the last 3 years. Last injection
gave him 2-3 months of relief. Of note, he has a protein C
deficiency and he is on Coumadin. He sees his vascular
surgeon, Dr. who manage his Coumadin. His
primary care physician is Dr. . 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 3 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 1 chondromalacia on the medial femoral condyle and grade 1 chondromalacia on the medial tibial plateau. The meniscus was torn with a small radial tear at the mid body. This encompassed approximately 25% of the meniscal width and it was intact to probing after debridement with a meniscal biter and shaver. The intercondylar notch revealed an frayed ACL and intact PCL. The ACL had 2 loose bodies at the base and was debrided back to a stable rim with the shaver The lateral joint had grade 1 chondromalacia on the lateral
femoral condyle and grade 1 chondromalacia on the lateral tibial plateau. The meniscus was torn with a small degenerative tear at the mid body. This encompassed approximately 20% of the meniscal width and it was intact to probing after debridement with a meniscal biter and shaver. There were multiple loose bodies anteriorly and in the suprapatellar pouch approx 1 cm in diameter that 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 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,plus multiple loose bodies and chondromalacia
PROCEDURES:
1. Arthroscopic Left partial Medial, Lateral meniscectomy. (29881)
2. Arthroscopic shaving chondroplasty Left patellofemoral joint (29877)
3. Arthroscopic multiple loose body removal Left Knee (29874)
SURGEON:
ASSISTANT:
ANESTHESIA:
General.
ESTIMATED BLOOD LOSS:
25cc
IV FLUIDS:
700cc
INDICATIONS FOR PROCEDURE: is a 45 y.o. male well known to me from my previous
practice at for a longstanding
history of left knee pain. He has had 6 surgeries on his left
knee including ACL reconstruction with a bone-tendon-bone
allograft. He had hardware removal and then three subsequent
arthroscopies. He has had no surgery for the last 25 years.
He reports swelling, crunching and sharp anterior pain and
popping as well as instability. It hurts to sit on a toilet
without having his leg extended. He has had no physical
therapy or injections for the last 3 years. Last injection
gave him 2-3 months of relief. Of note, he has a protein C
deficiency and he is on Coumadin. He sees his vascular
surgeon, Dr. who manage his Coumadin. His
primary care physician is Dr. . 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 3 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 1 chondromalacia on the medial femoral condyle and grade 1 chondromalacia on the medial tibial plateau. The meniscus was torn with a small radial tear at the mid body. This encompassed approximately 25% of the meniscal width and it was intact to probing after debridement with a meniscal biter and shaver. The intercondylar notch revealed an frayed ACL and intact PCL. The ACL had 2 loose bodies at the base and was debrided back to a stable rim with the shaver The lateral joint had grade 1 chondromalacia on the lateral
femoral condyle and grade 1 chondromalacia on the lateral tibial plateau. The meniscus was torn with a small degenerative tear at the mid body. This encompassed approximately 20% of the meniscal width and it was intact to probing after debridement with a meniscal biter and shaver. There were multiple loose bodies anteriorly and in the suprapatellar pouch approx 1 cm in diameter that 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 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.
