vabrown1213
New
PROCEDURE:
The inferior lateral portal and inferior medial portal were made with #15 blade knife approximately 0.5 to 0.75 cm in length each after sterile injection of sterile solution of ropivacaine 0.5% with epinephrine, 10 cc portal between the two portals. The incisions were made. The blunt trocar was placed in the knee joint per se. The arthroscopy camera was placed in the inferolateral portal. A thorough evaluation of the knee was performed. The following findings were noted. There was significant osteochondral defect to the apex of the patella. It was a grade 3 osteochondral lesion measuring approximately 2 cm x 1.5 cm in diameter. The patient's patella appeared to track appropriately within the trochlear groove. I did not appreciate any lateral or medial wear of the patella and/or the trochlear groove. The medial gutter was with full of small cartilaginous loose bodies, the largest measuring approximately 1 cm x 2-3 mm in thickness. The medial joint space revealed a relatively pristine osteochondral surface to both tibia and femur. The meniscus was without any evidence of tear. No myxoid degeneration noted. Multiple loose bodies were noted under the meniscus. There were also loose bodies on the lateral joint. Once again, the lateral joint was pristine as well with no meniscal tear or pathology other than loose bodies. The intercondylar notch reveals a very gracile anterior cruciate ligament with some remaining fibers that are fairly loose to probe examination. However, on anterior posterior drawer's test, there is an excellent endpoint with some stability to the knee. The arthrotome blade was placed in the inferomedial portal and a chondroplasty of the patella was performed removing only the loose unstable osteochondral layer. Representative pictures were obtained. The loose bodies were retrieved with the use of the arthrotome blade and the knee is flexed and probed for any further loose bodies. None were found. Copious irrigation was carried out throughout the knee. From the intercondylar notch, a biopsy of chondral tissue was removed in sufficient quantity to send to the Carticel Genzyme Tissue Transplant Center for growth for the potential replacement or repair of the osteochondral lesion in the future. This was placed in the back table in sterile solution and placed in the kit for Genzyme Biosurgery Department. The appropriate protocol was followed.
The inferior lateral portal and inferior medial portal were made with #15 blade knife approximately 0.5 to 0.75 cm in length each after sterile injection of sterile solution of ropivacaine 0.5% with epinephrine, 10 cc portal between the two portals. The incisions were made. The blunt trocar was placed in the knee joint per se. The arthroscopy camera was placed in the inferolateral portal. A thorough evaluation of the knee was performed. The following findings were noted. There was significant osteochondral defect to the apex of the patella. It was a grade 3 osteochondral lesion measuring approximately 2 cm x 1.5 cm in diameter. The patient's patella appeared to track appropriately within the trochlear groove. I did not appreciate any lateral or medial wear of the patella and/or the trochlear groove. The medial gutter was with full of small cartilaginous loose bodies, the largest measuring approximately 1 cm x 2-3 mm in thickness. The medial joint space revealed a relatively pristine osteochondral surface to both tibia and femur. The meniscus was without any evidence of tear. No myxoid degeneration noted. Multiple loose bodies were noted under the meniscus. There were also loose bodies on the lateral joint. Once again, the lateral joint was pristine as well with no meniscal tear or pathology other than loose bodies. The intercondylar notch reveals a very gracile anterior cruciate ligament with some remaining fibers that are fairly loose to probe examination. However, on anterior posterior drawer's test, there is an excellent endpoint with some stability to the knee. The arthrotome blade was placed in the inferomedial portal and a chondroplasty of the patella was performed removing only the loose unstable osteochondral layer. Representative pictures were obtained. The loose bodies were retrieved with the use of the arthrotome blade and the knee is flexed and probed for any further loose bodies. None were found. Copious irrigation was carried out throughout the knee. From the intercondylar notch, a biopsy of chondral tissue was removed in sufficient quantity to send to the Carticel Genzyme Tissue Transplant Center for growth for the potential replacement or repair of the osteochondral lesion in the future. This was placed in the back table in sterile solution and placed in the kit for Genzyme Biosurgery Department. The appropriate protocol was followed.