DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Rheumatoid arthritis.
2. Genu valgum.
3. Degenerative joint disease of the knee.
4. Attenuated medial collateral ligament.
POSTOPERATIVE DIAGNOSES:
1. Rheumatoid arthritis.
2. Genu valgum.
3. Degenerative joint disease of the knee.
4. Attenuated medial collateral ligament.
OPERATION PERFORMED:
1. Total knee arthroplasty.
2. Medial collateral ligament reconstruction.
SURGEON: John Doe, MD
ANESTHESIA: General.
FINDINGS AND DESCRIPTION OF OPERATION: The patient was taken to the operating room and anesthesia administered. After adequate anesthesia, the patient was prepped and draped in a sterile manner. An anterior incision was made sharply through the skin and subcutaneous tissue. Dissection was performed on the medial retinaculum of the patella and a quad incision then made. The patella was retracted. The patellofemoral ligament was then incised. Dissection was performed anteriorly initially. No medial release was performed, but dissection at the edge of the medial collateral ligament was accomplished. Initially, a lateral release was performed. Longitudinal incision was made at the patellar retinaculum between the patella and the femur longitudinally to the fat. Dissection was then performed sharply to the tibia and 1 cm above the tibia anteriorly and posteriorly. All soft tissues anterior to the patient’s lateral collateral ligament were incised, and lateral collateral ligament was protected. The patient’s release was gauged and then the patient’s tibia cut was made. Care was taken to ensure minimal resection and to allow for restoration of the normal alignment. A 90-degree cut was made. The patient had significant trough made in the lateral posterior plateau. It was felt that augmentation may be necessary; however, with further balancing and bone resection at the tibia, augmentation was not necessary.
The patient’s distal femoral cut was made, normal amount, with balance at the appropriate center of rotation, followed by anterior and posterior cuts. Care was taken to ensure proper rotation, which did require some adjustment secondary to the hypoplastic lateral femoral condyle. The epicondylar access was utilized as a guide as well as Whitesides line. Although the patient had significant tracking laterally, Whitesides line was not felt to be accurate, so epicondylar access was key and was utilized. Further balancing was required. With the complete lateral resection, the thought was to either lengthen the lateral collateral ligament or recess the medial collateral. Recession was then performed at the medial collateral ligament. This involved identifying the epicondyle on the medial side, paying close attention to the attenuated medial collateral ligament. Once the structure was identified, #2 FiberWire was passed through it, and drill holes were placed. A punch was then utilized to allow for tunneling and sliding of the bone was performed. It was then tied over a button laterally. The trial reduction was made and then insert used that was smaller and then it was balanced in this manner.
The femoral cuts were made and Marcaine was injected, followed by placement of the cement. It had been mixed and was tacky and doughy. It was then placed over the tibia, tibial component placed and then the femoral component and patella. Knee was extended and then the tibial insert was exchanged after medial collateral ligament was tightened. Very good stability accomplished with equal flexion and extension gap to varus and valgus stress. The patient tolerated the procedure well and was then transferred to the recovery area where neurovascular exam revealed normal peroneal nerve function.
