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Medial meniscus tear.
POSTOPERATIVE DIAGNOSES: Medial meniscus tear.
Chondromalacia-patellofemoral and medial compartments.
PROCEDURES: Arthroscopic partial medial meniscectomy.
Chondroplasty-debridement of patellofemoral compartment and medial compartment.
Partial synovectomy, left knee.
INDICATIONS: This 37-year-old woman describes left knee pain and catching sensation about the medial joint line and swelling in the knee. She has difficulty bearing weight and any type of exercising. She underwent an MRI scan, which demonstrated a meniscus tear and marked chondromalacic changes. She presents now for surgical management after failed conservative treatment.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed on the operating table in the supine position. After instillation of successful general anesthesia, the left knee was examined. Range of motion of the knee was full and no laxity was noted to stress testing. At that point, the left leg was placed in the arthroscopic leg holder, the right leg in a well leg stirrup, and the left knee was sterilely prepped and draped. The left knee was injected with 60 mL of 0.25% Marcaine with epinephrine. Standard arthroscopic portals were established. Patellofemoral compartment showed was visualized and revealed a large amount of synovitis. A partial synovectomy was then carried out using a full-radius resector, removing a portion of the anteromedial fat pad, medial parapatellar plica, and synovium. The patella itself showed an area of grade 3 chondromalacia over the central to lateral area, measuring about 2 cm in size. The trochlear groove of the femur showed a large area of grade 3 chondromalacia with cartilaginous flaps. Medial compartment was then entered. There was an area of grade 3 chondromalacia of the weightbearing surface of the medial femoral condyle with loose cartilaginous flaps, measuring about 2 cm in size. There was a tear of the posterior horn of the medial meniscus, which was radial in nature, with a small posterior unstable fragment. The intercondylar notch revealed the anterior cruciate ligament to be intact. The lateral compartment was then inspected. There was a single superficial fissure in the tibial plateau and the remaining articular cartilage and meniscus cartilage was intact.
Straight and upbiting basket forceps were used to perform a partial medial meniscectomy, and the remaining medial meniscus was balanced using a full-radius resector.
A thorough chondroplasty-debridement was carried out of the patellofemoral compartment and medial compartment of the knee, using a full-radius resector. The joint was then thoroughly lavaged and evacuated of all fluid contents. The portals were closed with Vicryl and Steri-Strips. A light compressive dressing was applied, incorporating an Ace wrap from the toe to the thigh. The patient was then awakened from general anesthesia after tolerating the procedure well with no apparent complications. Estimated blood loss was zero and no drains were left.
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