PREOPERATIVE DIAGNOSIS:
Right knee pain, synovitis, chondromalacia.
POSTOPERATIVE DIAGNOSIS:
Right knee pain, synovitis with inflamed medial plica and
synovitis in all compartments with chondromalacia of the
patellofemoral joint including the patella and anterior femur.
PROCEDURE:
Arthroscopic examination with synovectomy, excision of plica,
and abrasion chondroplasty of patellofemoral joint. 29876.
SURGEON:
ANESTHESIA:
General LMA.
ESTIMATED BLOOD LOSS:
Minimal.
COMPLICATIONS:
None.
BRIEF CLINICAL HISTORY:
This is a 38-year-old white female with history of persistent
pain and soreness in front of the knee, especially getting out
from a chair with squatting and kneeling. She was known to
have some patellofemoral chondromalacia on MRI scan and
inflammation of the joint. Options of continued conservative
care versus surgery were discussed with her at length. She
requested surgical treatment.
PROCEDURE:
After taking informed consent, the patient was brought to the
operating room table in supine position. After administration
of general LMA anesthesia, the tourniquet was placed in right
proximal thigh, and the skin was prepped and 0.5 % lidocaine
with epinephrine was placed in the knee joint. Next, the
right leg was sterilely prepped, and draped in a routine
manner. Timeout was then performed. The patient was
identified, appropriate biopsy site was marked and she
received appropriate antibiotics. Next, an anterolateral
arthroscopy portal was then made and arthroscopic examination
was performed. Examination of the joint showed inflammation
in the suprapatellar area with this inflammation in the
suprapatellar bursa. The patellofemoral joint showed
chondromalacia grade II and III, grade II on the patella and
grade III on the anterior femur with a flap of cartilage. The
medial joint showed a thickened inflamed medial plica with
dropping of the edge of the femoral condyle. Medial joint was
examined. There was some synovium noted here with impingement
of the synovium in the joint. The meniscus was noted to be
intact.
Articular surface was normal in appearance. An anteromedial
portal was made and medial meniscus was probed throughout its
length and no obvious tears were noted. The notch area was
examined and the ACL and PCL were intact as was the ligament
of mucosum. The lateral joint was examined. There is some
inflamed synovium noted here also and some fraying of the
insight edge of the meniscus. This was debrided with a shaver
and punch ***. The remaining portion was probed, again
noted to be stable. The lateral compartment showed some mild
inflammation. Next, with the aid of shaver, synovectomy was
performed in all compartments including excision of the plica
and debridement of anterior medial joint and suprapatellar
area and debridement of the inflamed area of the femoral
condyle. Abrasion chondroplasty was then done on the patellar
and anterior femur back to stable cartilage. Remainder of the
exam was otherwise unremarkable. Next, the arthroscopy was
removed from the knee joint. Steri-Strips used to approximate
the skin edges. The port of the joint was infiltrated with 1%
lidocaine. A sterile dressing was applied. The patient was
transferred to recovery in
Right knee pain, synovitis, chondromalacia.
POSTOPERATIVE DIAGNOSIS:
Right knee pain, synovitis with inflamed medial plica and
synovitis in all compartments with chondromalacia of the
patellofemoral joint including the patella and anterior femur.
PROCEDURE:
Arthroscopic examination with synovectomy, excision of plica,
and abrasion chondroplasty of patellofemoral joint. 29876.
SURGEON:
ANESTHESIA:
General LMA.
ESTIMATED BLOOD LOSS:
Minimal.
COMPLICATIONS:
None.
BRIEF CLINICAL HISTORY:
This is a 38-year-old white female with history of persistent
pain and soreness in front of the knee, especially getting out
from a chair with squatting and kneeling. She was known to
have some patellofemoral chondromalacia on MRI scan and
inflammation of the joint. Options of continued conservative
care versus surgery were discussed with her at length. She
requested surgical treatment.
PROCEDURE:
After taking informed consent, the patient was brought to the
operating room table in supine position. After administration
of general LMA anesthesia, the tourniquet was placed in right
proximal thigh, and the skin was prepped and 0.5 % lidocaine
with epinephrine was placed in the knee joint. Next, the
right leg was sterilely prepped, and draped in a routine
manner. Timeout was then performed. The patient was
identified, appropriate biopsy site was marked and she
received appropriate antibiotics. Next, an anterolateral
arthroscopy portal was then made and arthroscopic examination
was performed. Examination of the joint showed inflammation
in the suprapatellar area with this inflammation in the
suprapatellar bursa. The patellofemoral joint showed
chondromalacia grade II and III, grade II on the patella and
grade III on the anterior femur with a flap of cartilage. The
medial joint showed a thickened inflamed medial plica with
dropping of the edge of the femoral condyle. Medial joint was
examined. There was some synovium noted here with impingement
of the synovium in the joint. The meniscus was noted to be
intact.
Articular surface was normal in appearance. An anteromedial
portal was made and medial meniscus was probed throughout its
length and no obvious tears were noted. The notch area was
examined and the ACL and PCL were intact as was the ligament
of mucosum. The lateral joint was examined. There is some
inflamed synovium noted here also and some fraying of the
insight edge of the meniscus. This was debrided with a shaver
and punch ***. The remaining portion was probed, again
noted to be stable. The lateral compartment showed some mild
inflammation. Next, with the aid of shaver, synovectomy was
performed in all compartments including excision of the plica
and debridement of anterior medial joint and suprapatellar
area and debridement of the inflamed area of the femoral
condyle. Abrasion chondroplasty was then done on the patellar
and anterior femur back to stable cartilage. Remainder of the
exam was otherwise unremarkable. Next, the arthroscopy was
removed from the knee joint. Steri-Strips used to approximate
the skin edges. The port of the joint was infiltrated with 1%
lidocaine. A sterile dressing was applied. The patient was
transferred to recovery in