RightKneearthroscopywithMenialMinisectomy.edited23 xScannedDocuments5
**You are required to choose one surgical procedure from chapters 18 – 24 research and scrub the procedure, and complete a 5-7 page Case Study All papers turned in must be typed, and neat, or points will be deducted from your work. Each document must be in APA format, cited sources with 1” margins, 12 font & Times New Roman (the cover page & reference pages are not included with the word count). The paper must be submitted to Blackboard.
Attached below is a sample from the previous sample. Attached is the surgical case.
Running head: Right Knee Arthroscopy With Menial Minisectomy 1
Right Knee Arthroscopy With Menial Minisectomy 12
Case Study: Right Knee arthroscopy with Menial Minisectomy
Charara N. Naziha
Instructor: Name
SUR 125 Surgical Technology
Date
Abstract
Old age or aging has been mainly considered to be one of the major cause of meniscus tears and other wide range of the knee problems that includes the misaligned knee cap or patella, torn anterior or posterior cruciate ligaments, fractures in the knee bones, swollen lining in the joint (synovium), broken ligaments of the knee, among others. Notably, there are diverse interventions that can be considered to treat meniscal tears and a mirage of factors that doctors have to consider. The methods could include non-operative management of degenerative meniscal tears. Additionally, a surgical procedure could be considered to identify the appropriate diagnosis for any aforementioned knee problem. This report investigates the arthroscopy with menial meniscectomy, an orthopedic hospital outpoint surgery on a 68-year-old patient with a torn meniscus in the right knee, leading to increased tolerance to day-to-day activities and exercises such as walking, jogging, squatting and sitting and standing, and walking up and down a flight of stairs.
Introduction
Case description
The patient was a 68-year-old male who was presented to the orthopedics for an outpatient elective/non-trauma surgery. The patient preoperative diagnosis indicates a tear of the lateral meniscus to the right knee resulting in right-sided medial knee pain. The patient presented with mild swelling of the knee, reduced knee joint motion, and tenderness that indicates a torn meniscus.
The knee joint system has the menisci that play an influential role, including shock absorption when pressure is exerted between your shinbone and thighbone and advancing stability when a person is executing motion. It also plays an essential role in the transfer load across the tibiofemoral articulation, which promotes physical support and stability. However, the Menisci is highly susceptible to damage, tear, and injuries from forceful twisting or rotation of the knee. Additionally, traumatic events and the degenerative nature of osteoarthritis, one of the most common forms of arthritis that affect millions of people worldwide, could increase the probability of damage in the knee cartilage (Abdulwahab & Almqvist, 2019). Meniscal repair of the medial meniscus, partial meniscectomy of the lateral meniscus, and microfracture of the right knee are all major surgeries that have to be minimally invasive and executed with the highest level of accuracy (Azam & Shenoy, 2016). The surgical procedure is very necessary when patients above 60 years are experiencing knee pain or are already diagnosed with the condition that causes pain. However, a diagnosis could sometimes warrant the need for a knee arthroscopy with Menial Minisectomy (Abdulwahab & Almqvist, 2019). In most cases, the surgical procedures are done to promote meniscal preservation, which is crucial for helping the patient regain their physical knee and leg capabilities and mobility. Native joint preservation thorough procedure such as knee Arthroscopy has gradually gained relevance over the recent years in the medical field as researchers advance efforts to find reliable and lasting solutions (Barnds et al., 2019). While multiple non-surgical interventions such as surgical, pharmacologic, and conservative physical therapy have been advanced before, this effectiveness in elderly patients is very low. Barnds et al., (2019) notes that as a result, patients aged above 60 years are mainly forced to undergo a knee arthroscopy with menial minisectomy to remove or repair torn menisci and facilitate recovery of the normal knee anatomy.
Method
Participants
A panel of six physicians completed the surgical procedure. The panel leader was the Surgeon, Eberhardt James P, DO. The panel also includes one nurse, a Certified Registered Nurse Anesthetist (CRNA), a circulator nurse, a surgical technologist, and a resident nurse to provide patient care. The roles of each member of the panel are clearly defined in the surgery log. The surgical technologist was tasked with preparing the surgical room, preparing and placing all instruments listed in the supplies list, positioning the instruments, and equipment settings. The surgical technologist also supported the surgeon and the rest of the team during the procedure by passing all medication and instruments used. The nurses were issued instructions on the positioning, equipment setting, medication, pre-procedure preparation instructions, and positioning of the preference card.
Research
The case study information follows majorly from previous learnings on this surgical procedure and the practical trial made in different procedures that I have been a part of. We have been part of many similar surgeries that seek to rectify diverse knee issues in the recent past. This surgery was part of the most progressive since it entails the processes of a conventional arthroscopy and menial meniscectomy. All surgical procedures were in line with the standards and new guidelines put in place at our facility and were presented in the surgery log issued beforehand. as Leopold (2017) notes critical gaps regarding this surgery and his observation presented a major need to advance into more advanced and better evidence based processes during the surgery. regarding The surgery log contained all relevant information regarding the surgical procedure. Again a briefing session was held by the panel before the surgery to discuss all dynamics of the procedure and prepare the panel to perform their roles. The session included reviewing the medical standards as presented in the facility guidelines, brainstorming, and presentation of diverse ideas and expectations of the surgery, among others.
Procedure
The patient was scheduled for a right knee arthroscopy with menial meniscectomy, a surgery that was intended to repair the torn meniscus. The Surgeon, Eberhardt James P, DO, formed the panel that would serve a primary role in the procedure. As part of the preoperative procedure, the surgical patient was placed in line with a conventional knee arthroscopy set-up that includes placing the body on the operating table supine with a strap safety with the left arm and right arms extended on Arm board Amsco 2008. Both the left and left legs were flexed with uniquely colored leg holder and leg well. The panel created the routine arthroscopy protocol after administering the general anesthesia 30 ml of (Ropivacaine (Naporine) injection 0.5%, and administration of Epinephrine (Adrenaline) injection 1mg/ml anaphylaxis that manages the patient’s allergic reaction to any insect bites, and substances, improved breathing, stimulate the heart to manage a drop in blood pressure and reduce the probability of swelling (Howe & Burton, 2019).
After a successful administration and induction of general anesthesia supplemented by Adrenalin, the process began to complete a standard arthroscopy with Menial Minisectomy. The surgeon introduced the arthroscopy through the anterior, inferior and medial, and lateral portals. The arthroscopy was then advanced through the intercondylar notch that is adjacent to the PCL and into the posterior knee. The knee scope was positioned facing down, and a posterior meniscal stump debrided gently with a focusing l radius resector. The tibial attachment site in the posterior horn was identified using a camera. The surgeon then abraded the perimeniscal capillary plexus and the posterior capsule. The ablation promoted bleeding and stimulate fibrovascular healing response around the attachment site. A partial Menial Minisectomy was conducted to excise the torn meniscus. The surgeon then passed through the cannula placed in the medial arthroscopy portal a suture device to engage the meniscus for placement and repair through the placement of vertical simple sutures. Finally, in torn meniscus reconstruction, the surgeon passed a guidewire from the distal to the proximal through an incision in the proximal tibia tunnels. The maneuver was in line with the anatomical position of the posterior attachment of the posterior horn medial meniscus on the tibia. Finally, all standard procedures were completed to facilitate anatomical repair. They include pulling the meniscus lateral and anterior and tuck it onto the bone tunnel. All through the surgery, a sodium chloride 0.9% irrigation solution was used. Finally, all incisions were approximated using Monocryl. A dry sterile bandage was then applied, and the patient was prepared for post-operative procedures that include physio-therapy
Results
In the first follow-up session after the surgical procedure and physiotherapy intervention, the patient ticked right on most of the presented with increased knee mobility, decreased pain, and improved knee postures. There were improvements with the knee values for the range of motion of joints as values approach the normal flexion and extension value for a range of motions (Between 0- 1300 range for knee flexion and 120 – 0 0 range for extension. Additionally, the patient reported 55/80 in the Lower Extremity Functional Scale (LEFS), a self-report questionnaire containing 20 questions about the patient’s ability to perform everyday tasks. As Repo et al., (2019) notes, these results presented increased tolerance to day-to-day activities and exercises such as walking, jogging, squatting and sitting and standing, and walking up and down a flight of stairs. There were higher scores on the Lower Extremity Functional Scale (LEFS). The physical therapist report shows that the patient has resumed simple physiotherapy exercise to help with the recovery process as part of his post-surgery procedures. The patient has displayed negative results on the McMurray tests on the right side and the Apleys Compression and, which both are indicative of a recovering meniscal damage.
Overall, following the Right Knee arthroscopy with Menial Minisectomy surgical procedure, the patients presented with increased knee mobility, decreased pain, and improved knee postures. There were improvements with the knee values for the range of motion of joints as values approach the normal flexion and extension value for a range of motions (Between 0- 1300 range for knee flexion and 120 – 0 0 range for extension. Additionally, the patient presented increased tolerance to day-to-day activities and exercises such as walking, jogging, squatting and sitting and standing, and walking up and down a flight of stairs. There were higher scores on the Lower Extremity Functional Scale (LEFS).
Discussion
The etiology and epidemiology of the injuries to the Meniscus affirm that the surgery was necessary to help the patient resume their normal activities and recover from the torn menisci. Overall, data from multiple sources advance that more than 85% of patients with meniscal and anterior cruciate ligament (ACL) require an arthroscopic treatment. In some cases, an arthroscopy with menial meniscectomy could be necessary to facilitate anatomical repair of the knee, especially when these meniscal tears are degenerative. Notably, evidence from diverse research shows that males aged more than 60 years are more likely to suffer meniscal tears due to increased exposure to risk factors such as work-related kneeling, standing, squatting, climbing, and falls, among others (Marzo & Kumar, 2007). Notably, the clinical presentation of torn meniscus includes tendons and effusion of the joint line, a knee that is functionally unstable, stiffness and pain that increase in intensity by loading and flexing the knee, and a sound such as clicking and knocking on the knee. However, not all these symptoms represent a torn meniscus, and symptoms such as joint line tenderness could be linked with osteoarthritis, osteochondral defects, collateral ligament injury, or fractures. Therefore, the pre-surgical procedures call for the explicit inclusion of a physical therapist who facilitates the diagnosis processes through standard tests such as the McMurray’s test, the Steinman’s test, the Ege’s test, the Thessaly Test, or an MRI scan.
Overall, all processes in this surgical procedure align with the standards procedures. The result affirms the importance of the Menisci in supporting a patient to perform diverse roles supported by the menisci of the knee, such as load-bearing and overall body stability. Therefore, there is an increased necessity to pursue the standard surgical efforts for the repair, restoration, or replacement of the meniscal tissues to prevent degeneration of the premature articular cartilage (Abram et al., 2020). Notably, other interventions that have been previously considered have unsatisfactory outcomes. They include meniscal transplantation. However, older patients may not do well with most of these procedures, especially if they are overweight or have existing conditions that affect recovery and rehabilitation. In the case of this patient, all these factors were considered. The clinical examination, as well as the patient’s history, were found to align to most other patients with torn meniscus Still, an MRI is important since it reveals the exact site where the damage to the meniscus has occurred and facilitates the surgical team to plan, obtain informed consent from the patient and prepare all potential medication, solutions, and equipment for the surgical procedure.
Overall the surgery was a success and was conducted with minimal intrusion. The patient was discharged the same day the surgical procedure was conducted and was initiated into physical therapy and counseling to ease the burden of psychological outcomes of the surgery. Over time, various tests have been carried out, and the panel has met the patient on several occasions to explore the success or precautions of the surgical outcomes. Therefore, there is sufficient evidence supported by literature that the surgical procedure provides the client a better chance of recovering from meniscus damage and restoring their knee capabilities. However, further research is required to explore how the goals of his surgery can be sustained in the long run and how multiple approach can be used to improve the outcomes of surgery. This case study presents the success and effectiveness of a Right Knee arthroscopy with Menial Minisectomy toward enabling elderly patients to recover and reuse their normal activities in the events of traumatic events that cause knee disorders such as torn knee meniscus. The surgery was critical in improving the surgical outcomes and improve the physical functionalities for an elderly male patient with a torn meniscus.
References
Abram, S. G., Hopewell, S., Monk, A. P., Bayliss, L. E., Beard, D. J., & Price, A. J. (2020). Arthroscopic partial meniscectomy for meniscal tears of the knee: a systematic review and meta-analysis. British journal of sports medicine, 54(11), 652-663.\
Abdulwahab, T., & Almqvist, K. (Eds.). (2019). Meniscus of the Knee: Function, Pathology and Management. BoD–Books on Demand.
Azam, M., & Shenoy, R. (2016). The role of arthroscopic partial meniscectomy in the management of degenerative meniscus tears: a review of the recent literature. The open orthopaedics journal, 10, 797.
Barnds, B., Morris, B., Mullen, S., Schroeppel, J. P., Tarakemeh, A., & Vopat, B. G. (2019). Increased rates of knee arthroplasty and cost of patients with meniscal tears treated with arthroscopic partial meniscectomy versus non-operative management. Knee Surgery, Sports Traumatology, Arthroscopy, 27(7), 2316-2321.
Howe, T., & Burton, A. (2019). Pharmacology for the Surgical Technologist-E-Book. Elsevier Health Sciences.
Leopold, S. S. (2017). Appropriate use? Guidelines on arthroscopic surgery for degenerative meniscus tears need updating
Marzo, J. M., & Kumar, B. A. (2007). Primary repair of medial meniscal avulsions: 2 case studies. The American journal of sports medicine, 35(8), 1380-1383.
Repo, J. P., Tukiainen, E. J., Roine, R. P., Sampo, M., Sandelin, H., & Häkkinen, A. H. (2019). Rasch analysis of the Lower Extremity Functional Scale for foot and ankle patients. Disability and rehabilitation, 41(24), 2965-2971.
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