Left knee arthroscopy with synovectomy, two compartments Chondroplasty patella

PREOPERATIVE DIAGNOSIS:

Left knee medial meniscus tear, possible anterior cruciate ligament injury.

POSTOPERATIVE DIAGNOSIS:

Synovitis of left knee with chondral lesion of the patella medial facet.

OPERATION PERFORMED: 

1. Left knee arthroscopy with synovectomy, two compartments. 

2.  Chondroplasty patella.

ANESTHESIA:  Spinal.

BLOOD LOSS:   Minimal.

FLUIDS:  Crystalloid.

COMPLICATIONS:  None.

INDICATIONS FOR SURGERY:   The patient is a 22-year-old male with chronic left knee pain.  Risks, benefits, and alternatives were discussed.  The patient wished to proceed with surgery.

OPERATIVE PROCEDURE:  The patient was identified, brought to the operating room and placed in supine position on table.  After induction of a spinal anesthetic, the patient received Ancef preoperatively.  Left knee was sterilely prepped and draped.  Positive findings on exam.  More tenderness over the joint line preoperatively and over the medial aspect of the knee.  However, Lachman test negative on exam and negative under the anesthetic.  At this time, the pivot shift test was also negative.  The left knee was sterilely prepped and draped in the usual fashion.  A knee holder was placed.  The patient's portal sites were established after inflating the joint with saline.  The findings were as follows:  The patient was noted to have chondromalacia, medial patella facet, lateral facet intact, medial compartment showed intact.  Medial meniscus, lateral meniscus, ACL, and PCL were grossly intact and probed carefully.  There was synovitis anteriorly and anteromedially as well as suprapatellar pouch.  This was resected using full-radius resector as well as along the anterior aspect of the knee.  After completion of our synovectomy and hemostasis was obtained, we went back to the patella.  The patella was then addressed using a cautery device at a setting of one where we smoothed the articular cartilage, loose chondral flaps.  This was a grade 2 A to 2 B lesion.  No exposed bone.  Once we completed this, we checked patellar tracking once more which was essential.  All instruments were then removed from the knee.  The knee was closed with nylon sutures and injected with Marcaine for postoperative pain control.