DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Chronic lateral ligament instability of the right ankle.
POSTOPERATIVE DIAGNOSES: Chronic lateral ligament instability of the right ankle and chronic synovitis and intraarticular loose body.
OPERATION PERFORMED: Modified Brostrom lateral ligament reconstruction of the right ankle and arthrotomy with removal of loose body, right ankle.
SURGEON: John Doe, MD
SEDATION: General endotracheal anesthetic supplemented with a popliteal nerve block for postop pain management.
INDICATIONS FOR OPERATION: This is a (XX)-year-old male who has been followed for chronic lateral ligament instability of his right ankle. He had an MRI scan that showed thinning of the anterior talofibular ligament along with a loose body. He had continued persistent symptoms with normal daily activities with multiple and recurrent inversion sprains. The patient was treated with anti-inflammatories, physical therapy and a double upright brace. Preoperatively, the risks of a general anesthetic, including cardiac and/or pulmonary complications, were discussed with the patient. Additionally, the risks, including but not limited to infection, DVT, PE, stiffness, loss of motion, possible continued symptoms or development of posttraumatic changes which may necessitate further surgery in the future or leave the patient with continued disability, were discussed. The patient understood these risks and was agreeable to the procedure.
DESCRIPTION OF OPERATION: After consent was obtained, routine intravenous lines were begun. A popliteal nerve block was placed in the right lower extremity and the patient underwent general endotracheal anesthetic. A thigh tourniquet was applied. Routine Betadine prep and drape was performed. After exsanguination with an Esmarch bandage, the tourniquet was elevated to 350 mmHg pressure and found to be functioning well. A lateral incision was then made anteriorly over the ankle, beginning just slightly medial to the distal fibula and this was then carried distally, posteriorly towards the peroneal tendon sheath. The subcutaneous tissues were incised with Bovie cautery. Bovie cautery was utilized to coagulate bleeders. Care was taken to avoid any injury to the sural nerve and branches of the superficial peroneal nerve. The edge of the inferior extensor retinaculum was exposed as was the anterior capsule. A small portion of the peroneal tendon sheath was incised to allow exposure of the calcaneofibular ligament, which was present but somewhat stretched out. The anterior talofibular ligament was essentially nonexistent other than some scarified capsule. The calcaneofibular ligament was cut transversely and then it was repaired with the ankle slightly everted with a 2-0 Ethibond suture in a pants-over-vest fashion. Similarly, anteriorly, a loose body was seen within the capsule and this was shelled out and then in a similar pants-over-vest fashion, the anterior capsule and remnants of the anterior talofibular ligament were also repaired with the ankle slightly everted so that this complex was stabilized. To reinforce this, the lateral edge of the inferior extensor retinaculum was also sutured over the repair to the periosteum of the distal fibula. The wounds were irrigated with antibiotic solution. The subcutaneous tissues were closed with a running 3-0 Vicryl suture and the skin with horizontal mattress 4-0 nylon suture. Betadine-soaked Adaptic dressing was applied. The patient was placed in a short leg splint, holding the ankle dorsiflexed 90 degrees and slightly everted. Tourniquet was released after 60 minutes. There were no complications noted. He was extubated in the operating room and transferred to the postanesthesia recovery room where capillary refill was intact to the right lower extremity.