PREOPERATIVE DIAGNOSIS: Left medial meniscus tear.
POSTOPERATIVE DIAGNOSIS: Left medial meniscus tear.
PROCEDURE: Left knee arthroscopy with partial medial meniscectomy.
DETAILS OF PROCEDURE: The patient was brought to the operating room and placed supine on the operating table. After induction of general anesthesia, he was positioned for the surgery with an arthroscopic leg holder on the upper left thigh. The left lower extremity was sterilely prepped and draped in the usual fashion from the tips of the toes to the midthigh. An anterolateral arthroscopic portal was created, the arthroscope was placed using a blunt trocar for the arthroscopic cannula. Diagnostic arthroscopy of the knee was then begun. Evaluation of the patellofemoral articulation was unremarkable. Evaluation of the medial compartment demonstrated intact articular surfaces on the distal femur and proximal tibia. He was noted to have a complex degenerative-appearing posterior horn medial meniscus tear. From an anteromedial portal, we used a basket forceps and suction shaver to debride the meniscus back to a stable rim of cartilage. We used the probe to assess meniscal stability and post partial meniscectomy was satisfied. The intercondylar notch was next visualized. The ACL and PCL were intact and normal in appearance. Evaluation of the lateral compartment demonstrated an intact lateral meniscus and no articular abnormality. The femoral trochlea likewise was in good condition. We irrigated thoroughly with sterile saline solution and the arthroscopic equipment was removed. The wounds were closed with interrupted subcuticular Vicryl sutures.
CODES :
Cpt: 29881 , Dx-717.2 , Px-80.6.
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PREOPERATIVE DIAGNOSIS: Left medial meniscus tear.
POSTOPERATIVE DIAGNOSIS: Right Lateral meniscus tear.
PROCEDURE: Right knee arthroscopy with partial Lateral meniscectomy.
DETAILS OF PROCEDURE: The patient was brought to the operating room and placed supine on the operating table. After induction of general anesthesia, he was positioned for the surgery with an arthroscopic leg holder on the upper right thigh. The left lower extremity was sterilely prepped and draped in the usual fashion from the tips of the toes to the midthigh. An anterolateral arthroscopic portal was created, the arthroscope was placed using a blunt trocar for the arthroscopic cannula. Diagnostic arthroscopy of the knee was then begun. Evaluation of the patellofemoral articulation was unremarkable. Evaluation of the lateral compartment demonstrated intact articular surfaces on the distal femur and proximal tibia. He was noted to have a complex degenerative-appearing posterior horn lateral meniscus tear. From an anteromedial portal, we used a basket forceps and suction shaver to debride the meniscus back to a stable rim of cartilage. We used the probe to assess meniscal stability and post partial meniscectomy was satisfied. The intercondylar notch was next visualized. The ACL and PCL were intact and normal in appearance. Evaluation of the medial compartment demonstrated an intact lateral meniscus and no articular abnormality. The femoral trochlea likewise was in good condition. We irrigated thoroughly with sterile saline solution and the arthroscopic equipment was removed. The wounds were closed with interrupted subcuticular Vicryl sutures.
CODES :
Cpt: 29881 , Dx-717.43 , Px-80.6.
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PREOPERATIVE DIAGNOSES:
1. Right medial and lateral meniscus tears.
2. Osteoarthritis, right knee.
POSTOPERATIVE DIAGNOSES:
1. Right medial and lateral meniscus tears.
2. Osteoarthritis, right knee.
PROCEDURES:
1. Right knee arthroscopy with partial medial and lateral meniscectomies.
2. Chondroplasty, medial, lateral, and patellofemoral compartments.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed supine on the operating table. After induction of general anesthesia, he was positioned for the surgery with an arthroscopic leg holder around the upper right thigh. The left lower extremity was well padded. Both were allowed to dangle free from the end of the table. The right lower extremity was sterilely prepped and draped in the usual fashion from the tips of the toes to the midthigh. The knee was approached through an anterolateral arthroscopic portal.
The arthroscope was placed using blunt trocar. Diagnostic arthroscopy of the knee was then begun. Evaluation of the patellofemoral articulation demonstrated significant degenerative change in the femoral trochlea. Grade IV chondromalacia was noted in the large area of the femoral trochlea. There was some grade II and III chondromalacia in the retropatellar surface as well. The medial gutters were without loose bodies. Evaluation of the medial compartment demonstrated extensive chondromalacia in the medial femoral condyle involving the majority of the weightbearing portion of the condyle. There was a complex degenerative appearing posterior horn of the medial meniscus tear of the very deep radial component. Radial component reached the meniscocapsular junction. From an anteromedial portal, we used a basket forceps and suction shaver to debride the meniscus back to stable rim of cartilage. This required resection of the majority of the posterior horn of the medial meniscus. We then performed a chondroplasty of the medial femoral condyle smoothing and contouring the articular surface and stabilizing the rim of the articular lesion with suction shaver and basket forceps. Again, this involved the majority of the weightbearing portion of the medial femoral condyle. Some thinning and fissuring of the tibial plateau was noted as well. The intercondylar notch was next visualized. The ACL and PCL were intact and normal in appearance. Evaluation of the lateral compartment demonstrated a degenerative posterior horn of the lateral meniscus tear. In addition, he had significant chondromalacia in the lateral femoral condyle and articular surface as well. We again used a suction shaver and basket forceps to debride the meniscus back to a stable rim. We then treated the lateral articular lesion with chondroplasty as described above. Attention was returned to the femoral trochlea, the rim of the articular lesion was stabilized and contoured. We then irrigated thoroughly with sterile solution and arthroscopic equipment was removed. The wounds were closed with interrupted subcuticular Vicryl sutures. Steri-Strips and a bulky postoperative dressing were applied. The knee was infiltrated with Marcaine, Depo-Medrol, and Duramorph for postoperative analgesia. The patient was taken to postanesthesia recovery in satisfactory condition.
CODES :
Cpt: 29880 , Dx-717.2, 717.43, 733.92, 717.7, 715.36, Px-80.6.
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