DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left knee patellar instability with subluxation.
POSTOPERATIVE DIAGNOSIS: Left knee patellar instability with subluxation.
OPERATION PERFORMED:
1. Left knee arthroscopy with arthroscopic lateral release.
2. Proximal patellar realignment with vastus medialis obliquus advancement.
SURGEON: John Doe, MD
ANESTHESIA: General.
TOURNIQUET TIME: 90 minutes.
BLOOD LOSS: 25 mL.
FLUIDS: Lactated Ringer’s.
SPECIMENS: None.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed on the operating table in the supine position. General anesthesia was induced. The left lower extremity was prepped and draped in the usual sterile fashion. The limb was exsanguinated, and the tourniquet was inflated to 300 mmHg. At this point, a standard diagnostic arthroscopy of the left knee was performed using a standard anterolateral and anteromedial portal. Following findings were obtained: Grade 2 chondromalacia on the medial patellar facet at the patella. Otherwise, normal lateral, normal medial meniscus, normal ACL, normal articular cartilage on the femoral condyle and the tibial plateau. Subluxing patella at 30 degrees flexion was noted. At this point, a Mitek VAPR hook-shaped electrode was placed through the anterolateral portal. The arthroscope was inserted through the anteromedial portal and an arthroscopic lateral release was performed from distal to proximal. At this point, the patella was then freely mobile, medial and lateral. At this point, a radius shaver was inserted into the knee and a chondroplasty was performed of the medial patellar facet. At this point, all the arthroscopic instruments were removed.
A slightly off-midline longitudinal incision was then made on the anterior aspect of the knee. This incision was carried through the skin and subcutaneous tissue. The skin flaps were then elevated exposing the vastus medialis muscle. At this point, the vastus medialis tendon was then incised adjacent to the rectus tendon and down along the superomedial portion of the patella and then the medial retinaculum was incised along the inferior border of the vastus medialis. At this point, the vastus medialis was advanced distally and laterally to the mid portion of the patella. It was sutured to the anterior and mid portion of the patella using 2-0 FiberWire mattress sutures. This was done multiple times securing a strong repair. The knee was then taken through a full range of motion from 0 to 90, and the patient was found to have excellent normal tracking of the patella with no further lateral instability.
At this point, the remaining retinaculum was closed with a combination of 2-0 FiberWire figure-of-eight sutures. At this point, the overlying fascia was closed with 3-0 Vicryl single interrupted sutures. Skin was closed with 3-0 Vicryl single interrupted sutures and the 4-0 nylon subcuticular suture. Prior to this, the wound was copiously irrigated with normal saline. An intraarticular pain pump was inserted through a separate incision, and also a Hemovac drain was then inserted into the knee joint as well. A bulky sterile dressing was applied. The patient tolerated the procedure well and was taken to recovery in stable condition.
