Case Study: Management of 55-year-old Female with Left Knee

Quadriceps Tear, Lateral Meniscus Tear, and Partial ACL Tear

The patient is in our office, with complaints of left knee pain and loss of function for the past 1 month. The patient sustained an injury in a fall, the patient states she can not put pressure on the knee. The patient also states she feels a gap between the knee cap. The patient works as a security guard at a clinic and sustained the injury when she was trying to restrain a patient and fell. 

The pain is extremely severe in intensity (10/10). The pain is constant. The problem has been getting unchanged since it started. Ice and ibuprofen make the symptoms better. She is currently taking muscle relaxants and NSAIDs for pain. She is unable to walk unassisted and uses a cane for walking.

The patient has a medical history significant for diabetes and psoriasis both well controlled with medications. She denied any past surgical history. The patient is allergic to shellfish. She is a non-smoker and consumes alcohol socially.

On physical examination, the patient was calm conscious cooperative, and well oriented to time place and person. On examination of the left knee, there was moderate swelling. The patient was unable to do active straight leg raise. A void was felt over the proximal pole of the patella. The range of motion was restricted secondary to pain. There was no distal neurovascular deficit.

The examination of the contralateral knee was unremarkable.

X-ray of the left knee suggested a soft tissue swelling anterior to the patella and patellar tilt.

X-ray of the left knee in lateral view 

X-ray of the left knee in lateral view.

MRI suggested a complete rupture of the quadriceps tendon at the patellar attachment. The joint effusion communicates through the tendon defect with a prepatellar fluid collection. Low-grade intrasubstance tear at the origin of the ACL. Radial tear at the free edge of the lateral meniscal body.

MRI of the left knee in the sagittal and coronal view  MRI of the left knee in the sagittal and coronal view 2

MRI of the left knee in the sagittal and coronal view.

MRI of the Left Knee in the sagittal section 

MRI of the Left Knee in the sagittal section.

All treatment options including surgical and nonsurgical were discussed with the patient at length. Risks, benefits, and alternatives were also discussed with the patient. The patient agreed to go ahead with the surgical procedure.

PREOPERATIVE DIAGNOSES:

  1. Left knee quadriceps tear.
  2. Left knee lateral meniscus tear.
  3. Left knee partial tear of the ACL.

POSTOPERATIVE DIAGNOSES:

  1. Left knee quadriceps tear.
  2. Left knee lateral meniscus tear.
  3. Left knee partial tear of the ACL.
  4. Grade 2 to grade 3 chondral damage trochlea.

OPERATION:

  1. Knee arthroscopy with partial lateral meniscectomy.
  2. Arthroscopic chondroplasty of Patella.
  3. ACL debridement, left knee.
  4. Open repair of the quadriceps, left knee.

PROCEDURE:  The patient was taken to the operating room where he was put on a well-padded operating table.  General anesthesia was induced.  The left lower extremity was put in a high tourniquet. The left knee was prepared aseptically and draped in the usual fashion. A time-out was called.  A tourniquet was applied and inflated.  Tourniquet time was 103 minutes. 

A left lateral entry portal was made and the scope was entered.  The knee was lavaged with a lot of fluid to clean up the blood.  The visualization was not properly to the blood.

The scope was moved to the medial tibiofemoral compartment.  The medial meniscus was intact.  There was no chondral damage.  The scope was moved to the intercondylar area where partial ACL tear of the lateral side was found.  The debridement was done. The rest of the 90% of ACL was intact.

The scope was moved to the lateral tibiofemoral compartment where the tear of the medial edge of the lateral meniscus was present.  The tear was cleaned using right-sided biters and shavers.  The rest of the lateral meniscus was intact. There was no chondral damage.

The scope was moved to the patellofemoral joint where trochlea grade 2 to grade 3 chondral damage was found. The chondral damage was debrided from the medial portal and followed by the lateral portal.  Copious lavage was performed.  Arthroscopic pictures were taken and saved. 

The scope was removed. The knee was extended. The table was extended and a proper draping was performed.  A midline vertical incision was put and centered over the superior pole of the patella.

The quadriceps tendon was found to be completely ruptured. The tendon was debrided. The stump of the tendon was over the patella was removed. The bone was decorticated to fresh bleeding margins.  Three transosseous tunnels were made and silk ties were put for future use. 

Now, the tendon was sutured using #5 FiberWire with a Krackow stitch x2.  The four tails of the #5 FiberWire were passed through the three tunnels into the patella.  The lateral and medial FiberWires were tied on to each other and the knots were buried.

The lateral and the medial retinaculum was repaired using #2 FiberWire.  After proper closure, the wound was again lavaged.  The closure of the skin was performed using Vicryl #2-0 and Monocryl #4-0. 

The arthroscopic portals were closed using nylon #4-0. The dressing was performed using Steri-Strips, Adaptic, 4 x 4s, ABD, Webril, and Ace wrap. The tourniquet was removed.  The patient was extubated and moved to the recovery unit in a stable condition.

Disclaimer – Patient’s name, age, sex, dates, events have been changed or modified to protect patient privacy.

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16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
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21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
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21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
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23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
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The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
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19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
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00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
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23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
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19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
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Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
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22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
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Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
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21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
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16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.