Left knee arthroscopy Partial lateral meniscectomy Abrasion chondroplasty, left medial femoral condyle

PREOPERATIVE DIAGNOSIS:  Torn left lateral meniscus.

POSTOPERATIVE DIAGNOSES:

1.  Torn left lateral meniscus.

2.  Osteochondritis dissecans involving the medial femoral condyle with grade 3 lesion.

3.  Partial anterior cruciate ligament tear.

PROCEDURE:

1.  Left knee arthroscopy.

2.  Partial lateral meniscectomy.

3.  Abrasion chondroplasty, left medial femoral condyle.

SPECIMENS:  None.

COMPLICATIONS:  No intraoperative complications.

ANESTHESIA:  General endotracheal anesthesia.

ESTIMATED BLOOD LOSS:  Minimal.

TOURNIQUET:  350 mmHg.

INDICATIONS:  The patient is a 30-year-old gentleman who sustained an injury to the left knee while ATV riding.  He was initially treated conservatively, but failure of conservative efforts led to indicate for an MRI, which revealed positive lateral meniscal tear.  Procedure is indicated for surgical intervention.  Risks and benefits have been discussed prior to the procedure and all questions were answered.

PROCEDURE IN DETAIL:  He was brought into the operating room after adequate anesthesia had been obtained.  Intravenous antibiotics were given.  Placed in the left arthroscopic leg holder after the tourniquet applied to the left upper thigh.  He was prepped and draped in the usual sterile fashion.  At this point, the limb was exsanguinated and the tourniquet inflated to 350 mmHg.  Stab wound was made at the lateral infrapatellar region of the knee after establishing portal position with the spinal needle.  Scope was introduced into the knee and the knee distended.  At this point in time, the patellofemoral articulation revealed some mild fibrillation.  No evidence of significant patellofemoral abnormalities.  No patellar maltracking.  We entered into the medial compartment of the knee where there was no evidence of medial meniscal tear present.  We established the medial portal under direct vision with the use of a spinal needle initially followed by a stab wound.  We probed the medial structures and noted them to be intact.  However, there was an area of approximately a centimeter in the region of the weightbearing portion of the medial femoral condyle where there was area of an OCD with chondral lesion, flap of chondral cartilage.  We then turned our attention to the remainder of the knee.  We evaluated the intercondylar notch with the ACL and was noted to be partially detached from its normal origin.  We then entered the lateral compartment where we noted a radial tear in the posterior horn of the lateral meniscus.  Again, we then placed using the combination of biters and full-radius shavers.  We were able to clean the meniscal tear on the lateral posterior horn to smooth the rim without detaching the peripheral rim.  We then probed the remaining structure, which was noted to be intact.  There were no further significant degenerative changes about the lateral compartment and no significant chondral lesions.  At this point, we placed the shaver into the medial compartment of the knee and performed a standard abrasion chondroplasty abrading the detached and fibrillated cartilage over the medial femoral condyle.  This was not taken down fully to subchondral bone.  At this point, we copiously irrigated the knees, removed all instruments, suctioned dry prior to this, and then closed the portals with a nylon interrupted suture 3-0 followed by infiltration of the knee with 22 mL of 0.5% Marcaine without epinephrine.  Application of dressing including Adaptic sterile gauze dressing ABD, Webril, Ace wrap, polar cuff.  He was then awoken in the operating room brought stable to Post Anesthetic Care Unit in good condition.  Again, prior to the procedure, the limb was exsanguinated and the tourniquet was up, total of 30 minutes.  There were no intraoperative complications noted.