DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left knee medial meniscus tear.
POSTOPERATIVE DIAGNOSES:
1. Left knee medial meniscus tear.
2. Left knee lateral meniscus tear.
3. Left knee osteoarthritis.
OPERATION PERFORMED:
1. Arthroscopic partial medial meniscectomy.
2. Arthroscopic partial lateral meniscectomy.
SURGEON: John Doe, MD
ANESTHESIA: LMA anesthesia.
DESCRIPTION OF OPERATION: After obtaining informed consent and correctly identifying the patient, the patient was brought to the operating room and placed on the operating table in supine position. After adequate anesthesia was obtained and intravenous antibiotics were given, the left lower extremity was prepped and draped in the usual sterile fashion. A time-out was then taken to confirm the identity of the patient’s correct extremity and the consented procedure. After this time-out, the skin inferomedial and inferolateral to the patella was injected with 0.5% ropivacaine. A small horizontal stab incision was then made inferolateral to the patella as an anterolateral portal. Arthroscopic camera was inserted via this lateral portal. The knee was then distended and diagnostic arthroscopy then ensued.
The suprapatellar pouch was visualized. There was immediately noted to be multiple small chondral fragments floating in the suprapatellar pouch with mild synovitis. The undersurface of the patella also revealed grade 2 and grade 3 changes of chondromalacia. The trochlear groove also revealed grade 3 and grade 4 changes of chondromalacia, and the patella appeared to track laterally with respect to the trochlear groove. The medial gutter was then visualized, and again, there were multiple small loose chondral fragments that were freely floating in the medial gutter.
The medial compartment was then entered as the knee was held in the flexed position with valgus stress. Spinal needle was then inserted inferomedial to the patella for localization of the anteromedial portal. Once its position was confirmed, a horizontal stab incision was then made. Arthroscopic probe was inserted. The medial meniscus was then visualized and probed, and there was noted to be a degenerative radial tear at the junction of the middle and posterior one-third of the meniscus. Upon probing this, the radial fragment also had a small vertical component, which rendered this beak-like tear unstable.
Using a combination of arthroscopic biters and arthroscopic shavers, the torn meniscus was excised back to a stable rim with a smooth contour and transition zone. The arthroscopic probe was used to confirm, upon completion of the meniscectomy, that the remaining rim of meniscus was stable. There was also noted to be global grade 3 and grade 4 changes of chondromalacia of the medial femoral condyle with some unstable edges.
Arthroscopic shaver was then used to gently debride the unstable edges of cartilage until a stable rim remained to ensure that no further delamination would occur. The medial tibial plateau was also visualized, and there was no evidence of unstable chondral fragments, but there was noted to be grade 2 and grade 3 changes of arthritis.
The intercondylar notch was then visualized. The anterior cruciate ligament was visualized and probed. There was mild attenuation but no evidence of a frank rupture. The lateral compartment was then entered as the knee was held in a flexed position with valgus stress. Immediately noted was a degenerative tear of the midbody of the lateral meniscus. This was gently debrided using an arthroscopic shaver. Underlying this area of degeneration of the lateral meniscus, it was noted that on the lateral tibial plateau, there was grade 3 and grade 4 changes of chondromalacia with unstable cartilaginous edges.
The arthroscopic shaver was then used to gently debride the unstable cartilage until a stable rim of cartilage remained, again ensuring that no further delamination occurred. The lateral femoral condyle also revealed grade 3 and grade 4 changes of arthritis.
Upon completion of the partial medial and partial lateral meniscectomies, the large Veress needle was inserted into the anteromedial portal, and the arthroscopic fluid inflow was attached to this anteromedial portal. This allowed for copious irrigation. The knee was drained via the lateral portal until the fluid ran clear with no further evidence of cartilaginous debris.
Upon completion of the irrigation and drainage, the portal sites were then closed using buried simple interrupted sutures of 4-0 Monocryl. The knee was then injected intra-articularly with 0.5% ropivacaine. Steri-Strips were applied. Sterile dressings were applied. The patient tolerated the procedure well. There were no complications. All needle, sponge and instrument counts were correct, and the patient was transported stable and extubated to the postanesthesia care unit.
