DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right medial meniscal tear.
POSTOPERATIVE DIAGNOSIS: Right medial meniscal tear.
OPERATION PERFORMED:
1. Right medial meniscectomy.
2. Right lateral meniscal debridement.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General with endotracheal tube intubation.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old gentleman with a history of right knee pain. He is status post left side meniscectomy with satisfactory result. He was seen in clinic secondary to ongoing right knee pain. Imaging studies demonstrated a right medial meniscal tear.
After discussion of the risks and benefits of surgery including but no limited to continued pain, DVT and PE, infection or need for additional surgery, the patient opted to move forward with elective right knee arthroscopy with possible meniscectomy.
DESCRIPTION OF OPERATION: The patient was met in the preoperative holding area. Correct patient, correct side, as well as planned procedure was verified. The skin was marked by the surgical attending. He was also met by Anesthesia. They confirmed correct patient and correct side.
At this point, the patient was brought to the operating room and placed on the operative table in the supine position. Care was taken to pad any bony prominences. Two grams of antibiotics, namely Ancef, was given. At this point, anesthesia was induced without issue. The patient’s correct side was verified. A nonsterile tourniquet was applied to his thigh. Care was taken to pad the tourniquet well. Leg was then prepped and draped in usual sterile fashion. Prior to completion of prepping and draping, the foot plate of the bed was dropped such that the patient’s leg was free. The bed was raised to appropriate height. After prepping and draping, time-out was performed. Correct patient, correct status, as well as planned procedure was again verified. Verification was again made of antibiotics given.
At this point, a lateral parapatellar incision was planned using the sterile marker. Using the 15 blade, incision was made through skin and underlying subcutaneous tissue, carrying to the capsule. The knee was extended while the arthroscopic obturator was placed through the lateral portal. This was carried up underneath the patient’ patella. The camera was then placed and correct joint placement was confirmed. The joint was filled with sterile normal saline. Inspection of the patella was carried out. This did show some grade 2 and grade 3 osteoarthritic changes along the lateral surface of the patella.
The scope was then brought down to medial gutter and no loose bodies were identified. It was brought into the medial compartment such that the meniscus could be evaluated. A posterior horn tear in the medial meniscus was identified. This tear capsulated the majority of the posterior horn. Using a combination of straight and upright biters as well as arthroscopic shaver, the tear was removed and a stable edge was established. Using the probe, the edge was evaluated and noted to be stable. Care was taken to remove any loose meniscal tissue from the medial joint space.
At this point, the scope was brought across the central portion of the joint. The ACL was identified. This was noted to be intact. Scope was then moved to the lateral compartment. There was noted to be significant amount of fraying along the inner edge of the lateral meniscus. No distinct tear was identified. This fraying was debrided using combination of straight biter and arthroscopic shaver. Using the arthroscopic probe, the stable edge was identified.
The camera was then brought through the lateral gutter, and there was no noted foreign bodies identified. This was brought back to the patellofemoral space. Documentation was made throughout the arthroscopic procedure using the camera to tape pressures.
Copious amounts of irrigation were then run through the patient’s joint, again making sure not to leave behind any loose bodies. Note that once the scope was brought into the medial compartment at the start of the procedure, a medial portal was established in usual fashion, that is using a spinal needle to identify appropriate location of the portal followed by 15 blade through the skin and subcutaneous tissue and capsule and followed by the obturator followed by the arthroscopic probe.
Once irrigation was complete, the knee joint was then drained and portals were closed using 3-0 nylon, arthroscopic stitch fashion. A dry sterile dressing was applied. The patient was then awakened from anesthesia and transferred to the operating room stretcher. There were no complications. Total tourniquet time was 24 minutes. This tourniquet was inflated to 275 mmHg after limb exsanguination using a sterile Esmarch. All counts were correct x2 at the end of the case.
