PREOPERATIVE DIAGNOSIS: Left knee pain, medial patellar subluxation.
POSTOPERATIVE DIAGNOSIS: Left knee pain, medial patellar subluxation.
PROCEDURES PERFORMED:
1. Arthroscopically assisted left medial retinacular release.
2. Limited debridement of medial facet of patellar chondral surface.
SURGEON: John Doe, MD
ANESTHESIA: General.
TOURNIQUET TIME: 0 minutes.
ESTIMATED BLOOD LOSS: 20 mL.
SPECIMEN: None.
COMPLICATIONS: None noted.
DISPOSITION: Stable to postanesthesia care unit for postoperative recovery.
OPERATIVE FINDINGS: Upon insertion of the trocar, no fluid was extravasated from the joint. A diagnostic arthroscopy was performed with the following findings: In the patellofemoral compartment, there was grade 2-3 chondromalacia present along the medial facet of the patella. The trochlea was intact and in pristine condition. It was noted that there is a tight medial retinaculum. There is also minimal synovitis present. The medial compartment of the knee demonstrated intact medial meniscus. The chondral surfaces were pristine and in good condition. The ACL graft from her prior ACL surgery was intact and in good condition. The lateral compartment demonstrated intact lateral meniscus and pristine chondral surfaces.
DESCRIPTION OF PROCEDURE: The patient was properly identified in the preoperative holding area. She was brought back to the operating room and placed in the supine position on the operating table for the above-mentioned procedures, including arthroscopically assisted left medial retinacular release. A well-padded tourniquet was applied to her left upper thigh. After satisfactory induction of general anesthesia, the leg was positioned in a well-leg holder. The left leg was then prepped and draped in the usual sterile manner. A time-out was performed to confirm the patient, site of surgery, and type of surgery to be performed.
A standard anterolateral arthroscopic portal was established using a #11 blade. The trocar was inserted. No fluid was extravasated from the joint. A diagnostic arthroscopy with above-noted findings was performed. Under direct vision, an 18-gauge needle was used to establish the anteromedial arthroscopic portal and was made with a #11 blade. The probe was inserted into the medial compartment and the medial meniscus was probed. No meniscal tear was noted.
Attention was then turned to the patellofemoral compartment. The medial retinaculum was noted to be tight, and using a 30-degree Arthrotec, the medial retinaculum fibers were released down to subcutaneous superiorly to the muscle fibers. It was noted that the patient had improved excursion of flexion and extension of her knee after releasing the retinaculum. No complications were noted and the skin was intact.
We then turned our attention to the medial facet of the patella. A 4.5 shaver was utilized to debride synovitis as well as chondromalacia present along the medial facet of the patella. The knee was then copiously irrigated with lactated Ringer’s. A medium Hemovac drain was placed through the anteromedial arthroscopic portal. The incisions were sutured using a simple 3-0 nylon suture. The incisions were dressed with sterile Adaptic, dry gauze, ABD, and Webril. A medial bolster pad was applied to the knee. Ace wrap was then applied followed by an ice pack.
Prior to applying dressings, 30 mL of 0.5% Marcaine was infiltrated into the joint via the anterolateral arthroscopic portal. After the dressings were applied, the patient was awakened from anesthesia and transferred to a stretcher to return to the PACU for recovery. A tourniquet was not utilized during the surgery. There were no complications noted prior to the patient leaving the operating room.
