OPERATION: Right knee arthroscopy with medial and lateral meniscectomy.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old woman with progressively increasing right knee pain. Recent MRI revealed fairly extensive posterior horn medial meniscal tear. Due to failure of conservative care, she has elected to proceed with arthroscopic evaluation with debridement. The foreseeable risks and benefits of this procedure were thoroughly explained to her. All of her questions were answered.
PREOPERATIVE DIAGNOSIS: Posterior horn medial meniscal tear, right knee.
POSTOPERATIVE DIAGNOSES:
- Extensive degenerative posterior horn medial meniscal tear.
- Leading edge lateral meniscal tear.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: Minimal.
FLUIDS: 700 mL lactated Ringers.
TOURNIQUET TIME: 12 minutes at 350 mmHg.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was brought into the operating room and placed supine on the operating room table. After institution of adequate general endotracheal anesthesia, preoperative dose of antibiotics was given prior to the initiation of the procedure. A thigh high tourniquet was placed high on the right leg and inflated as above. The entire right lower extremity was then prepped and draped in the usual sterile fashion.
A standard anteromedial porthole was created and diagnostic arthroscopy was then performed. There were no loose bodies in the knee. The patellofemoral articulation showed normal articulation with mild tilt but no subluxation. No plica was seen. The lateral compartment showed a leading edge degenerative tear along the midbody but no significant tearing anterior or posterior. There was no chondromalacia noted in this compartment. The ACL and PCL were intact in the notch. The medial compartment showed a fairly significant kind of a degenerative tear at the posterior horn that extended slightly into the midbody. No chondromalacia was noted there either.
With the diagnostic portion of the arthroscopy complete, attention was turned toward treating the pathology. Through the standard anteromedial working porthole, the medial meniscus was addressed first. This was accomplished with a straight and curved basket with a straight 4.5 and a curved 4.5 shaver. The tear was preferentially debrided along the leading edge on the inferior leaflet. It was contoured into the midbody with a stable transition zone. This was done predominantly with a curved shaver. The scope was switched from portal to portal several times to get the best angle of debridement.
Once this was accomplished, the lateral meniscus was addressed with a straight basket and a curved shaver again. This was a much smaller debridement overall. Final arthroscopic pictures taken. All excess fluid was drained. The 2 portals were closed with interrupted 3-0 nylon sutures and a dry sterile dressing was applied. The patient was awoken from anesthesia and transferred to the recovery room in satisfactory condition without complication.
