DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left recurrent patellar subluxation.
POSTOPERATIVE DIAGNOSIS: Left recurrent patellar subluxation.
OPERATION PERFORMED:
1. Left knee diagnostic arthroscopy.
2. Open Roux-Goldthwait procedure, left knee.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
DRAINS: None.
SPECIMENS: None.
ESTIMATED BLOOD LOSS: Less than 5 mL.
COMPLICATIONS: None.
DISPOSITION: Stable to postanesthesia care unit for postoperative recovery.
OPERATIVE FINDINGS: Upon diagnostic arthroscopy of the left knee, the following findings were noted:
1. In the patellofemoral compartment, the chondral surfaces were in good condition, and there was no synovitis present. There was lateral subluxation of the patella noted.
2. The medial gutter demonstrated no synovitis or loose bodies.
3. The medial compartment demonstrated intact meniscus with pristine chondral surfaces.
4. The intercondylar notch demonstrated an intact robust ACL. Intraoperative Lachman test was negative.
5. The lateral compartment demonstrated intact meniscus with pristine chondral surfaces.
6. The lateral gutter demonstrated no synovitis or loose bodies.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old who has had recurrent subluxations of his left patella. On physical examination, his Q angle is normal, but his medial retinaculum was torn, and he was easily subluxated and dislocated in regard to his patella laterally. At this point, we recommended that he undergo a left knee arthroscopy with a possible Roux-Goldthwait procedure, medial plication, and lateral release. Risks and benefits were discussed with the patient, and an informed consent was obtained.
DESCRIPTION OF OPERATION: The patient was properly identified in the preoperative holding area. He was brought back to the operating room and placed on the operating room table in the supine position. A well-padded tourniquet was applied to his left upper thigh. After satisfactory induction of general anesthesia, the patient was positioned with a lateral leg holder. The left leg was then prepped and draped in the usual sterile manner. A standard lateral arthroscopic portal was made using an 11 blade. The trocar was inserted, and there was no fluid extravasated. The arthroscope was inserted, and the above-noted findings were observed. The knee was then copiously irrigated with lactated Ringer’s, and the arthroscopic instruments were removed. The leg was then exsanguinated with an Esmarch and the tourniquet inflated to 300 mmHg.
A midline longitudinal incision, approximately 8 cm in length, was made overlying the patellar tendon. A 10 blade was utilized to incise through the skin and down to the subcutaneous tissue. A sharp dissection was performed of the subcutaneous tissue with a 10 blade to elevate medial and lateral flaps of the subcutaneous tissue. The medial and lateral borders of the patellar tendon were identified as well as the tibial tubercle. A fresh 10 blade was used to make a longitudinal incision in the patellar tendon from the inferior pole of the patellar tendon to the tibial tubercle to lift off the lateral portion of the patellar tendon. The lateral portion of the patellar tendon was then passed underneath the medial portion of the patellar tendon and reapproximated to pull the patella back to midline. The distal end of the incised patellar tendon was reapproximated down to the medial aspect of the tibial tubercle. A 0 Ethibond was used to reapproximate the patellar tendon with figure-of-eight sutures and to properly secure the patellar tendon to both the tibial tubercle as well as the medial portion of the tendon. A medial plication was then performed with a 0 Ethibond without any difficulty. The knee was flexed and extended. It was noted that the patella tracked normally and did not subluxate any further.
At this point, the knee was copiously irrigated with lactated Ringer’s. The deep tissue was closed with a few inverted 0 Vicryl sutures. The subcutaneous tissue was closed using inverted 2-0 Vicryl sutures. A 4-0 Monocryl was run in a subcuticular fashion. Benzoin and Steri-Strips were applied. The arthroscopic portal was closed using a 3-0 nylon suture. Incisions were dressed with Adaptic, sterile gauze, ABD pad, Webril and Ace wrap. A Polar Pad was also applied. The patient was placed into a hinged knee brace. The tourniquet was let down with a total tourniquet time of 30 minutes. The patient was transferred back to the postanesthesia care unit for postoperative recovery.
