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Thread: osteochondritis dissecans

  1. #1
    Join Date
    Apr 2007

    Default osteochondritis dissecans

    AAPC: Back to School
    any suggestins on this?

    Internal derangement, left knee.

    POSTOPERATIVE DIAGNOSIS: Unstable osteochondritis dissecans, left knee.

    PROCEDURE: Left knee arthroscopy with synovectomy and arthrotomy, with open reduction and internal fixation of osteochondritis dissecans, including drilling of the osteochondritis dissecans base.

    ASSISTANT: Eric Gardner, M.D.

    ANESTHESIA: General.

    PREPARATION: ChloraPrep.

    INDICATIONS: The patient is an 18-year-old female who, two years ago, underwent an in-situ pinning of osteochondritis dissecans. MRI demonstrated interval healing. She presents now with catching, which has been ongoing for the last 6 weeks. Her MRI showed partial healing of an osteochondritis dissecans but no unstable fragments. She presents for evaluation and treatment. The risks and benefits of surgery as well as the need for postoperative rehabilitation were discussed with the patient, who understood and consented to the operation.

    DESCRIPTION OF PROCEDURE: The patient was seen in the holding area, where she confirmed that the left knee was the operative extremity. We initialed the operative site and she was then taken to the operating room where, following induction of general anesthesia, a tourniquet was placed high on the left thigh. The left leg was prepped and draped in sterile fashion. A timeout was performed and the OR team agreed that the left knee was the operative extremity. The leg was exsanguinated with an Esmarch bandage and the tourniquet was inflated to 300 mmHg. The incisions were made, and the scope was placed in the joint and the knee was visualized in stepwise fashion. The patellofemoral articulation appeared normal, as did the lateral compartment. The ACL was intact. The medial compartment, however, demonstrated a 1 x 1.5-cm unstable articular cartilage fragment. The medial meniscus was probed and noted to be intact. Underlying bone appeared fibrotic. There did not appear to be any bone attached to the fragment. We felt this represented a treatable lesion. The tourniquet was deflated and then I went out and spoke with Whitney's parents with regard to treatment options of debridement versus microfracture versus arthrotomy with open reduction and internal fixation of the cartilage defect. After consideration of the options, the parents consented to me doing the arthrotomy and trying to pin the cartilage defect. I then returned to the operating room, where the patient's leg was again exsanguinated with an Esmarch bandage. We had deflated the tourniquet prior to me going out to discuss the case with the patient's parents. An arthrotomy was made by enlarging the medial peripatellar portal. The medial retinaculum was opened. The chondral defect was examined and was noted to be 1 x 1.5 cm in diameter. The cartilage appeared to maintain normal contour. The base of the lesion was fibrotic and the scar tissue was debrided using a ring curette. I used a 2-mm drill to make multiple drill holes at the base of the lesion. I then reduced the articular cartilage fragment into the defect and pinned it using three 2-mm Arthrex bioabsorbable cartilage tacks. This provided excellent fixation, and I was able to take the knee through a full range of motion. The margins of the defect appeared stable. The wound was irrigated with Bacitracin-containing normal saline solution. Hemostasis was achieved using electrocautery. The capsule was closed with 0 Vicryl sutures. Subcutaneous tissue was closed in layers with Vicryl, and the skin was closed with Monocryl. Sterile dressing was applied. The patient was awakened and taken to the recovery room in stable condition. The sponge and needle counts were correct at the conclusion of the procedure, and blood loss was minimal.

  2. #2
    Join Date
    Apr 2007


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