DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left quadriceps tendon rupture.
POSTOPERATIVE DIAGNOSIS: Left quadriceps tendon rupture.
OPERATION PERFORMED: Repair of left quadriceps tendon rupture.
SURGEON: John Doe, MD
ANESTHESIA: General with postoperative femoral block.
ESTIMATED BLOOD LOSS: Minimal.
URINE OUTPUT: Zero.
FLUIDS: 1250 mL of crystalloid.
TOURNIQUET TIME: 60 minutes.
DESCRIPTION OF OPERATION: The patient was seen in the preoperative holding area where the left lower extremity was marked as the correct site per the preoperative protocol. The patient received IV Ancef for antibiotic prophylaxis. He was then brought back to the operating room where he underwent general anesthesia per the anesthesia service without complications.
The left lower extremity was prepped and draped in the usual sterile fashion. The leg was exsanguinated and tourniquet was inflated to 250 mmHg. A midline incision was made curving just slightly medial to distal extent. Sharp dissection was performed down through the skin and subcutaneous tissues. There was noted to be a complete rupture of the quadriceps tendon just proximal to the insertion. There was extension to both the medial as well as the lateral retinacula. There was a moderate amount of hematoma noted, which was expressed from the joint and lavaged with sterile saline. There was mild to moderate articular cartilage. No fractures were noted. At that point, the tendon edges were gently debrided several millimeters down, back to healthy-appearing tissue. The superior pole of the patella was then prepared using rongeur and a curette down to the bleeding bony surface. At that point, #5 Ethibond x2 were used to run a total of 4 strands of suture coming out distally in a running locking-type stitch. There was excellent tension taken up in the sutures with no gapping noted.
At that point, Beath needles were then placed in a staggered fashion through the patella, coming out near the inferior extent. Each of these was separated by a little bit more than a centimeter. The middle two sutures were then passed through the middle hole, followed by the medial and lateral sutures, out through their respective holes. Hemostats were then placed and we felt the repair to take up excellent tension without undue stress to about 30 degrees of knee flexion. At that point, the knee was then extended and the Ethibond sutures were tied. It should be noted that there was excellent stability of the patella within the trochlea without subluxation noted. The repair was reinforced with #1 Vicryl as well as the retinacular extension both medial and lateral. We felt we had an excellent repair. Again, the extremity flexed easily at 30 degrees without undue tension on the repair.
Subcutaneous tissues were closed with 2-0 Vicryl followed by running 3-0 Prolene suture for the skin. Steri-Strips were applied. A sterile dressing followed by an Ace wrap was then applied, followed by a knee immobilizer locked in extension. Tourniquet was deflated after 60 minutes. The patient was then given a femoral block by the anesthesia service. The patient was then awakened in the operating room, extubated and transferred to postanesthesia recovery in stable condition.