Case Study: Right Knee Arthroscopic Chondroplasty
in a 31-year-old male
Knee arthroscopy frequently involves the surgical treatment known as arthroscopic chondroplasty. Chondroplasty is specifically done to smooth out wounded cartilage in the knee to minimize friction in the joint. If the cartilage is just mildly to moderately worn, it is a possibility.
When you have an injured knee, you will not be able to bear weight on the knee. You’ll also have the sensation of giving way or being unstable. Your knee cannot be extended or flexed entirely. Your knee is red, painful, and swollen.
A 31-year-old patient visited our office with complaints regarding his right hip. No pain has been encountered but there is aching occasionally. It is not associated with weakness, numbness, tingling, swelling, redness, warmth, ecchymosis, catching or locking, popping, or clicking, buckling, grinding, instability, radiation down leg, drainage, fever, chills, weight loss, change in bowel or bladder habits.
There is an aching and burning on his right knee: anterior; medial. The pain is moderate. But with the help of Ice, rest, and brace relieves the pain. Factors like standing, walking, lifting, bending, and squatting worsened the pain.
However, there is no numbness, tingling, swelling, redness, warmth, ecchymosis, catching/locking, popping/clicking, buckling, grinding, radiation down leg, drainage, fever, chills, weight loss, change in bowel/bladder habits, weakness, and instability. Patient has a feeling of apprehension that the kneecap may pop out.
The inspection on his right and left knee showed no deformity, mass, induration, warmth, erythema, swelling, atrophy, or tibial torsion and normal pronation, axial alignment, and foot arch.
We discussed the treatment options for the patient’s diagnosis, which included living with the extremity as it is, organized exercises, medicines, injections, and surgical options. We also discussed the nature and purpose of the treatment options along with the expected risks and benefits.
I educated the patient regarding the inherent and unavoidable risks which include, but are not limited to anesthesia, infection, damage to nerves and blood vessels, blood loss, blood clots, and even death were discussed at length
. We also talked about the possibility of not being able to return to prior activities or employment, the need for future surgery, and complex regional pain syndrome.
We talked about the possibility of not being able to alleviate all the discomfort. Also, I explained there is no guarantee all the function and strength will return.
The patient also understands the risks of re-tear or failure to heal. We have discussed the surgical procedure as well as the realistic expectations regarding the risks, outcome, and post operative protocol.
The patient was taken to the operating room where he was placed on a well-padded operating room table. General anesthesia was induced. Right lower extremity was prepared and draped aseptically in the usual fashion.
Tourniquet was applied. Preoperative antibiotics were given. Esmarch was applied. Lateral entry portal was made. Presurgical examination under anesthesia showed grade 2 patellar laxity, but the patella was not dislocatable and about 50% of the lateral facet.
A lateral entry portal was made, and an arthroscope was entered. Examination of the knee showed a chondral fissure lesion on the medial facet of the patella grade 2 to grade 3.
Examination of the rest of the patella was intact. Examination of the medial compartment showed intact medial meniscus and medial femoral condyle cartilage.
Examination of the intercondylar notch showed intact ACL. Examination of the lateral compartment showed intact lateral meniscus and lateral femoral condyle cartilage. Shaver was Introduced from the medial portal and shaving of the medial facet of the patella where the tear was performed.
The scope was entered from the medial portal and shaving was again performed from the lateral portal. A 78-degree scope was again entered to examine and complete the debridement. There was no lesion to the medial patellofemoral ligament on the inner side. We decided not to do much medial patellofemoral ligament reconstruction.
The knee was lavaged thoroughly and irrigated. Closure was done using #4-0 nylon. Ropivacaine 9 cc with 1 cc of 40 mg of Depo-Medrol was injected into the knee.
Dressing was done using Xeroform, 4 x 4s, Webril, and Ace wrap. The tourniquet was removed. The patient was moved to the recovery unit in stable condition. The knee immobilizer was applied.
We have decided to do formal physical therapy as well as a home exercise program for rehabilitation of the knee. The patient did well after the surgery and continued physical therapy. Patient checked in for a follow up visit after a month and saw significant improvement on his knee.
Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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