Right knee pain

The patient is a very pleasant 47-year-old gentleman, who underwent right meniscectomy with Dr. on May 30, 2012. He did extremely well after this surgery but then when he was cleared to resume his normal activity, he hurt the knee while playing racquetball. A subsequent MRI of the right knee on August 23, 2012, showed a tear of the posterior horn of the medial meniscus which was similar to the prior MRI before surgery, but displacement of the fragment was new. The patient now has chronic right knee pain since that time.

He consulted with an orthopedic surgeon at the Hospital for Special Surgery approximately one month ago. that doctor said he is not a candidate for further meniscus surgery and that he is not a candidate for a total knee replacement either. He has told him that he has to “live with the pain.” he has had one glucocorticoid injection, non-image guided, since the re-tearing of that meniscus but this did not help at all. He presents today for evaluation regarding his right knee pain.

ASSESSMENT:
This is an active 47-year-old gentleman who teaches ice hockey and tries to remain active playing racquetball, who appeared to suffer a re-tear of his right posterior horn and body of the medial meniscus after meniscal repair and ACL debridement. He also has MRI confirmed and stable chondromalacia patella. He is requesting image-guided intervention in the knee with viscosupplementation.

IMPRESSION:
1. Right knee pain; suspected pain secondary to re-tear of meniscus in addition to chondromalacia patella; no plain film is here for review to assess degenerative osteoarthropathy.
2. Stable chondromalacia patella.

PLAN:
After thorough evaluation today as well as review of his medical history, I am fine with moving forward, at the patient’s request, with intervention today. I will perform an image-guided injection into the right knee of viscosupplementation and low dose glucocorticoid for therapeutic purposes. We will set him up in a regimented physical rehabilitation program as well.

Hopefully, with the series of three to five viscosupplementation injections combined with low-dose glucocorticoid and physical rehabilitation, we can begin to rehabilitate his knee appropriately. I have advised against him running or playing racquetball at this time. Should he not do well with physical rehabilitation combined with viscosupplementation and low-dose glucocorticoid, we may want to consider PRP injection into the knee. I also want to get copies of his plain films of the knee.

The patient seemed very happy with this visit today. I look forward working with him.

Of note, I did not have his past medical history intake form at the time of dictation.

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