PREOPERATIVE DIAGNOSIS: Internal derangement of the left knee.
POSTOPERATIVE DIAGNOSES:
- Displaced bucket-handle tear of the medial meniscus of the left knee.
- Grade 2 to 3 chondromalacia of the patella.
SURGICAL PROCEDURES PERFORMED:
- Video arthroscopy of the left knee with partial synovectomy and partial medial meniscectomy.
- Chondral debridement of the patella.
ANESTHESIA: General endotracheal.
SURGEON: John Doe, MD
INDICATIONS: This is a healthy (XX)-year-old male who twisted his left knee while at home. He had immediate pain along the mid medial joint line, inability to flex and extend it fully and it was painful. He had an MRI scan that was consistent with a medial meniscus tear and it was felt that an arthroscopy was indicated probably. The risks of general anesthetic including cardiac and pulmonary complications were discussed with the patient. In addition, the risks of infection, DVT, PE, stiffness, loss of motion, possible continued symptoms, recurrence of symptoms or development of posttraumatic changes, all of which may necessitate further surgery in the future, was discussed. He understood these risks and he was agreeable to the video arthroscopy of the left knee with partial synovectomy and partial medial meniscectomy and chondral debridement of the patella.
DESCRIPTION OF PROCEDURE: The patient was brought from day surgery for video arthroscopy of the left knee with partial synovectomy and partial medial meniscectomy and chondral debridement of the patella. The procedure was begun where general anesthetic and endotracheal intubation was performed. The left lower extremity was exsanguinated with an Esmarch bandage, and the tourniquet was elevated to 350 mmHg pressure and found to be functioning well. Leg holder was placed for positioning purpose only and routine Betadine prep and drape was performed.
Standard superomedial inflow portal was established. The inflow was provided by Arthrotec pump. Inferolateral and inferomedial portals were then established for the Arthrotec and instrumentation respectively, and the inflow was switched to the arthroscopic cannula. Here, in the medial side of the joint, there was an obviously displaced bucket-handle tear of the medial meniscus. This was probed, found to be very mobile, and it was excised by detaching it anteriorly and posteriorly with arthroscopic scissors and removing with a grasper. The edges were then trimmed back to intact meniscus using combination of basket forceps and motorized shavers. The medial femoral condyle and medial tibial plateau were all intact in regards to the articular cartilage. The anterior and posterior cruciate ligaments were intact. The lateral compartment was normal, including the lateral meniscus and both the lateral femoral condyle and tibial plateau articular cartilages.
On viewing the patellofemoral joint, there was some mild grade 2 to 3 chondromalacia of the patella involving the medial facet, and this was resected and was debrided with motorized shaver. The trochlear cartilage was intact. Lateral medial gutters and suprapatellar pouch area were all swept with no evidence of any loose bodies. The arthroscope was then switched to the inferomedial portal. The entire joint was reexamined from this portal, and no significant further pathology was seen. Slight further trimming of the medial meniscus remnant was performed using the basket forceps and shavers in the inferolateral portal.
Patellofemoral articulation was observed and found to be normal in regards to its alignment. The joint was then irrigated and evacuated of fluid. The entry portals were instilled with 30 mL total of 0.5% Marcaine without epinephrine. Steri-Strips were used to close the wound. Compression dressing was applied. The tourniquet was released after 36 minutes. The patient tolerated the procedure well. He was extubated in the operating room, transferred to the postanesthetic recovery room where the neurovascular status to the left lower extremity was grossly demonstrated to be intact.
