PREOPERATIVE DIAGNOSIS: Meniscal tear.
POSTOPERATIVE DIAGNOSIS: Meniscal tear with a chondral defect involving the lateral femoral condyle and trochlea.
PROCEDURES PERFORMED:
1. Arthroscopy with chondroplasty of the trochlea as well as chondroplasty of the lateral femoral condyle.
2. Partial lateral meniscectomy.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room in supine position. After induction of anesthesia, the right lower extremity was then prepped and draped in a sterile field in usual fashion. The limb was elevated, exsanguinated, and tourniquet inflated to 350 mmHg.
Anterolateral portal was used for scope and inflow. Anteromedial portal was used for probe and motorized instrument. Findings were as follows. The patient had significant trochlear chondromalacia up to grade 3 and 4. There were some areas of bare bone involving the trochlea. The undersurface of the patella was relatively smooth, but there were some changes as well. Some edges of the trochlea had free cartilaginous flap. This was debrided with the use of a full radius shaver down to stable cartilaginous rim. Medial compartment showed an intact medial meniscus and normal articular cartilage. The ACL was intact.
The patient’s pertinent pathology was noted on the lateral femoral condyle. A large chondral defect with a loose flap of articular cartilage was noted over the weightbearing portion of the lateral femoral condyle. This was removed with the use of basket forceps, removing the loose cartilage piece of flap. In addition, a lateral meniscus tear was noted, which was then trimmed again with the basket and smoothed down to a nice transition zone using a full radius shaver.
Following the meniscectomy and chondroplasty of the lateral femoral condyle, copious irrigation was then done until return fluid was clear. Marcaine 0.25% was then used to infiltrate the portals, which were then closed with 4-0 nylon. Compression dressing and Ace wrap were applied. The patient was brought to the recovery room in stable condition.
