DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right patellofemoral maltracking.
POSTOPERATIVE DIAGNOSIS: Right patellofemoral maltracking.
PROCEDURES PERFORMED:
1. Right knee arthroscopy.
2. Right knee Fulkerson osteotomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Minimal.
TUBES AND DRAINS: None.
SPECIMENS: None.
COMPLICATIONS: None.
CONDITION: The patient was transferred to the recovery room in stable condition after right knee arthroscopy and right knee Fulkerson osteotomy.
DESCRIPTION OF OPERATION: Following informed consent, the patient was taken to the operating room and placed supine on the operating room table for right knee arthroscopy and right knee Fulkerson osteotomy. Following adequate induction of general anesthesia, a tourniquet was applied to the right lower extremity. A lateral leg post was utilized. At this time, knee arthroscopy was begun. A standard inferolateral portal was identified. The scope was inserted into the knee.
Diagnostic arthroscopy revealed that the patient did have persistent subluxation of the patella laterally. The patient did have grade III/IV changes over the lateral patella facet. The trochlea was in good condition. The medial and lateral gutters were free of debris. The medial compartment was in pristine condition with no evidence of any articular cartilage abnormalities, no meniscus tears. The anterior cruciate ligament and the intercondylar notch were intact.
Examination of the lateral compartment showed there was no evidence of any lateral meniscus tear, no chondral abnormalities.
At this time, attention was then turned to the Fulkerson. The extremity was exsanguinated with the use of an Esmarch. The tourniquet was inflated to 300 mmHg. A midline incision was made, centered over the patella tendon. It was carried down through the subcutaneous tissues and the tendon as well as the tubercle were identified.
The incision was made lateral to the patella tendon, and it was carried up in a proximal direction, performing a lateral release which was continued to the point of the vastus lateralis.
The incision was continued distally in a lateral parapatellar fashion, and the incision was made medially in the medial parapatellar region and carried proximally to the level of the inferior pole of the patella. The soft tissue was retracted off the proximal tibia using Hohmann and a combination of drill bit, and a saw blade osteotomy was performed in the anteromedial to posterolateral orientation to allow anteromedialization of the tubercle, leaving a hinge distally.
Once the tibial tubercle was shifted in an anteromedial direction, total displacement was approximately 1.5 to 2 cm, medially and anteriorly. This was then secured in place with two 5.4 mm screws the appropriate length.
Using interrupted 0 Vicryl sutures in a figure-of-eight fashion, the lateral retinaculum in the distal aspect was reapproximated. Any bony prominences were removed with the rongeur.
The wounds were then copiously irrigated. The wounds were then closed in an interrupted manner with the use of 0 Vicryl suture, 2-0 Vicryl suture and a 4-0 Monocryl suture for the skin. A sterile well-padded compressive dressing was applied in the operating room as well as a hinged knee brace. The patient tolerated the procedure well.
