- Messages
- 54
- Location
- Murrells Inlet, SC
I am leaning towards 29884, due to the extensive scar throughout the knee, however the physician states major synovectomy. He mentions the gutters, suprapatellar pouch, and anterior compartment however I am missing inflamed or damaged synovial membrane. Should this be specifically stated? I would appreciate any feedback before I send the physician a query.
This case was originally anticipated as right knee arthroscopy with debridement of cyclops lesion and removal of tibial screw. (There is no mention of the tibial screw in the operative report)
POSTOPERATIVE DIAGNOSES: Right knee anterior cruciate ligament reconstruction, with arthrofibrosis.
OPERATIONS PERFORMED: Right knee arthroscopy with major synovectomy and notchplasty.
FINDINGS: Cyclops lesion was present and extensive scarring throughout the knee in the gutters as well as suprapatellar pouch and anterior compartment.
DESCRIPTION OF PROCEDURE: After a surgical time-out, routine medial and lateral portals were made. The sheath was placed in the knee over a blunt trocar through the lateral portal. A medial portal was made under direct visualization. The first thing I noticed was how hard it was to introduce the trocar in the knee. Very dense scar tissue. I then examined the suprapatellar pouch. He had extensive adhesions in the suprapatellar pouch. I took those down and extended that into the gutters. The patellofemoral joint showed some grade 2 changes of the patella with grade 1-2 changes of the trochlea. I then extended down the notch. He had an obvious cyclops lesion, which was debrided with a shaver and his ligament reconstruction was intact. He had extensive scarring throughout the anterior compartment and gutters. He had a scarred plica. Using the shaver, I debrided the gutters, the plica, and the anterior compartment. Following my synovectomy he showed impingement on the roof of the notch, so I did a notchplasty with a bur. There was clearly no impingement at the completion of notchplasty. I cleaned out the scar extensively throughout the knee. The procedure was then completed. The portals were closed with nylon. He was dressed with Xeroform, sterile gauze, ABDs, and tape. He was awakened and taken from the OR in stable condition
This case was originally anticipated as right knee arthroscopy with debridement of cyclops lesion and removal of tibial screw. (There is no mention of the tibial screw in the operative report)
POSTOPERATIVE DIAGNOSES: Right knee anterior cruciate ligament reconstruction, with arthrofibrosis.
OPERATIONS PERFORMED: Right knee arthroscopy with major synovectomy and notchplasty.
FINDINGS: Cyclops lesion was present and extensive scarring throughout the knee in the gutters as well as suprapatellar pouch and anterior compartment.
DESCRIPTION OF PROCEDURE: After a surgical time-out, routine medial and lateral portals were made. The sheath was placed in the knee over a blunt trocar through the lateral portal. A medial portal was made under direct visualization. The first thing I noticed was how hard it was to introduce the trocar in the knee. Very dense scar tissue. I then examined the suprapatellar pouch. He had extensive adhesions in the suprapatellar pouch. I took those down and extended that into the gutters. The patellofemoral joint showed some grade 2 changes of the patella with grade 1-2 changes of the trochlea. I then extended down the notch. He had an obvious cyclops lesion, which was debrided with a shaver and his ligament reconstruction was intact. He had extensive scarring throughout the anterior compartment and gutters. He had a scarred plica. Using the shaver, I debrided the gutters, the plica, and the anterior compartment. Following my synovectomy he showed impingement on the roof of the notch, so I did a notchplasty with a bur. There was clearly no impingement at the completion of notchplasty. I cleaned out the scar extensively throughout the knee. The procedure was then completed. The portals were closed with nylon. He was dressed with Xeroform, sterile gauze, ABDs, and tape. He was awakened and taken from the OR in stable condition