Bruna Mori

INDICATION

I went over the imaging with the patient

My knees looked like planets

I did recommend surgery given the locked knee

Like a cramp that wouldn’t end

We had a lengthy discussion regarding debridement versus repair

I was de-brided

The patient’s questions were answered

I still have questions

PROCEDURE

The patient was appropriately identified and marked in the preoperative area

It was me

They were then brought back to the operating room

Cardigan, theater, igloo

General anesthesia was induced

Before I breathed out

Prior to incision, time-out was done and antibiotics were given

Given a time-out

On diagnostic arthroscopy, the patient had grade 1 changes in the patellofemoral joint articular cartilage

Italian femur, bone broth

The gutters were normal in appearance and free of loose bodies

Gutters are clean

The medial compartment showed grade 1 and grade 2 articular cartilage without focal deficit

I can see

She had a large ossicle at the posterior root of the medial meniscus

Renegade cartilage

This had become unstable and torn

She’s come undone

Such that there was a large displaced flap in the joint

Kangaroos and flap-jacks

The bony fragment was incarcerated

She was caged

And had actually caused a chondral lesion on the tibial plateau underlying the site

A hidden gem

The quality of the meniscal tissue was “fair”

Mushy knee

The body and anterior horn were intact

Holding …

In the notch, the ACL and PCL were intact

Not as mushy

In the lateral compartment the cartilage and meniscus showed grade 1 2 changes without local deficit

Not overdrawn

After diagnostic arthroscopy, I returned to the medial compartment

Welcome back

I then used a shaver on bur mode to essentially debride away the ossicle which was quite large

She used a drill

In order to assist with this I actually did place a luggage tag stitch with 0 FiberWire through the posterior horn using the meniscal scorpion

Bon voyage

When I had sufficiently burred the bony area I then used a shaver along the edge peripherally to remove any debris.

Burred

Unfortunately as I debrided, it became clear that the tissue would not hold a repair

The tissue had no means

Therefore I made the decision to do a partial medial meniscectomy.

Ciao, meniscus

I used a bitter to morselize the piece

A morsel with Campari

I then shaved along the edge of the meniscus to create a clean contour.

A close shave

I continued to shave until I was satisfied with the partial meniscectomy.

A closer shave

I then probed the area

Hello, again

I closed my incisions with 3-0 Monocryl sutures

Sewn

I placed Steri-Strips, local anesthetic, and sterile dressing.

Vacuumed

The patient was  taken to postoperative care unit in stable condition

To drool