DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right knee lateral meniscus tear.
POSTOPERATIVE DIAGNOSES:
1. Right knee lateral meniscus tear.
2. Loose body.
3. Lateral femoral condyle chondral lesion.
OPERATION PERFORMED: Right knee diagnostic and operative arthroscopy with arthroscopic partial lateral meniscectomy, arthroscopic loose body removal and arthroscopic lateral femoral condyle microfracture.
SURGEON: John Doe, MD
ANESTHESIA: General and local.
ESTIMATED BLOOD LOSS: Minimal.
TOURNIQUET TIME: None.
COMPLICATIONS: None apparent.
DESCRIPTION OF OPERATION: After the establishment of a general anesthetic, IV antibiotics were given. The patient was positioned supine. The right lower extremity was prepped and draped in the normal sterile fashion. Using blunt trocars, superolateral and inferolateral portals were created. A medial portal was created under direct vision to protect the medial meniscus. Systemic evaluation of the knee was performed. The suprapatellar pouch had no significant loose bodies or arthrofibrosis. There was significant arthrofibrosis on the infrapatellar fat pad region and the medial and lateral gutters, which was debrided back to a stable base, freeing up the patellofemoral joint. There was no significant further impingement on the medial and lateral condyles. There were grade 2 changes on the undersurface of the patella diffusely, as well as in the trochlea, especially at 30-60 degrees of range of motion.
There were no grade 3 to 4 changes in this region. The medial femoral condyle had minimal grade 1 to 2 changes at medial tibial plateau, but no formal grade 3 to 4 changes were noted. The medial meniscus was stable per palpation without evidence of tear. The PCL was intact. The ACL had some looseness. Did have a firm endpoint with anterior drawer. Importantly, though, there was a large loose body anterior to the ACL, impinging into the notch, which was minimally scarred down to the ACL, impinging the notch with flexion, extension. This was removed with a basket after the medial portal was enlarged carefully and noted to be approximately 1 cm in length. Pictures were taken before and after this and anterior drawer was performed. There was a firm endpoint approximately 4-5 mm and stable per palpation.
Upon entrance of the lateral joint line, there was an anterolateral meniscus tear, which was gently debrided back to a stable base. There was significant synovial hypertrophy in this region over the lateral femoral condyle, which was gently debrided. The remaining portion of the anterior mid body was intact. There was a posterior horn lateral meniscus tear with instability, which was gently debrided back with a combination of baskets and shaver. Care was taken to protect the articulated surfaces. The lateral femoral condyle had demyelinating articular cartilage. This was down to bone and grade 4 in nature. There was delaminating cartilage around this. All loose cartilage was removed. The anterior weightbearing portion was inspected. Pictures were taken and followed by microfracture technique in approximately 3 mm increments. A microfracture awl was used to penetrate some chondral bone. Bleeding was achieved after the pump was turned off. Pictures were taken. The scope was removed. The knee was evacuated. The portals were closed with buried sutures, followed by Steri-Strips and the insertion in the portals and in the knee of 0.5% Marcaine with epinephrine for a total of approximately 25 mL. No apparent complications.
