NOTES - Surgical Procedures :
My operative report. How serious was it? - - Posted by Gimpie10 (Gimpie10), 24 October 2003
I have lived with a 10% tear to my ACL for 14 years and didn't have any of the problems I am now, 1 year post surgery. I have problems with my knee cap tacking, without any warning my knee will collapse and lock back causing me great pain, but it seems unstable, which it wasn't before the last injury or surgery repair. This is what was wrong with me and what was done. I need feed back because I am facing a visit with another doctor that will probably put me at P&S. OPERATIVE PROCEDURES:
POSTOPERATIVE DIAGNOSES:
1. Torn anterior cruciate ligament.
2. Torn medial meniscus.
3. Torn lateral meniscus.
4. Posttraumatic arthritis.
5. Patellofemoral stress syndrome. ((What does this mean))?
OPERATIVE PROCEDURES:
1. Arthroscopic anterior cruciate ligament reconstruction with Achilles tendon allograft.
2. Partial medial meniscetomy.
3. Partial lateral meniscectomy.
4. Micro fracture chondroplasty of lateral femoral condyle.
5. Insertion of a postoperative pain catheter.
OPERATIVE PROCEDURE;
Following induction of satisfactory general endotracheal anesthesia, the patient’s right knee was examined under anesthesia and noted to have a 2+ Lachman’s and pivot shift maneuvers, grade I-II MCL sprain. Standard antero-lateral and antero-medial portals were created with diagnostic arthroscopy performed through the antero-lateral portal. Diagnostic arthroscopy revealed marked lateral patellar tilt and early wear in the lateral patellar facet. Intercondylar notch was normal. The medial compartment of the knee joint revealed complex tear involving the posterior horn of the meniscus. There was also tear in the anterior horn of the meniscus. There was a grade II-III lesion in the lateral aspect of the weight bearing portion of the medial femoral condyle approximately 0.5 cm in diameter and not full thickness. Intercondylar notch showed an intact PCL and complete tear of the ACL. Lateral compartment of the knee joint revealed tear of the anterior horn of the lateral meniscus and a grade IV lesion on the weight bearing aspect of the lateral femoral condyle approximately 1 cm in diameter. Chondroplasty micro fracture approach was subsequently utilized to perform micro fracture chondroplasty of the lateral femoral condyle. Synovial resector and basket forceps were utilized to debride, debulk, and to balance the anterior horn tear of the lateral meniscus. This left approximately 80% of the meniscus intact. The posterior horn of the medial meniscus was debrided back to the meniscus capsular rim leaving approximately 20% to 30 % of the meniscus intact. All fibro osseous debris was removed with the synovial resector. The stump of the anterior cruciate ligament was subsequently removed, and a notchplasty was performed with routine mechanical instrumentation back to the over-the-top position. A 50-degree Acufex anterior cruciate ligament drill guide was then placed centrally in the knee joint, just anterior to the posterior cruciate ligament, a 3-cm horizontal incision was made over proximal medial third of the tibia, and drill guide was locked into position. Drill twist was driven centrally into the knee joint using arthroscopic instrumentation and over-reamed with a 9.5 mm diameter reamer. The bone hole was rasped. All debris was removed with the synovial resector.
An Arthrex over-the-top drill guide was then placed with the knee in 110 degrees of flexion and driven up to the anterior acromial cortex with the knee in 110 degrees of flexion and driven up to the anterior acromial cortex with Beath needle. This was held in position and reamed to a depth of 45 mm x 10 mm in diameter. The interference screw was cut through a separate stab incision. All instrumentation was removed from the knee joint. The graft was then loaded on the back of the Beath needle and manually advanced into the tunnel. It was fixed proximally with a 9 x 23-mm Bio-Absorbable screw from Arthrex. The graft was placed under tension, noted to be free of residual impingement in flexion and extension, and isometric with regard to positioning. A 1- x 23-mm screw was utilized to provide soft tissue fixation on the proximal tibia. The patient’s wounds were copiously irrigated and closed and non-absorbable and absorbable suture material. A bulky compressive dressing and Kling were applied. The patient was transferred from the operating room to the recovery room in good condition having tolerated the procedure well. Prior to closure, an Oratek electro thermal lateral release probe was utilized to perform a lateral retinacular release. The patient’s wounds were copiously irrigated as noted and closed in layers as noted. the patient was transferred from the operating room to the recovery room in good condition having tolerated the procedure well. The Pain-Buster pain catheter was placed in the suprapatellar pouch prior to closure.
Posted by dm (dm), 26 October 2003
It reads like you had multiple problems worked on at once. Most, if not all, of us are not medical professionals, so that's most likely why no one's replied. I imagine you must've done something spectacular to have all those problems. Sounds like everything was fixed without problems. Hope you heal up quick.
take care of that knee.
Updated Sat Nov 21 2009
