OT notes · Orthopaedics

Diagnostic and therapeutic knee arthroscopy (meniscectomy / debridement)

Usual anaesthesia
Spinal or general
Position
Supine near the edge of the table, thigh holder or lateral post on the operated side, other leg padded in a well-leg holder
Setting
elective

Operative note template for diagnostic knee arthroscopy with partial meniscectomy or debridement, with a filled example for a partial medial meniscectomy of a bucket-handle tear.

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Blank template

Follow this order in the case sheet. Tick the options that apply and fill the blanks.

Patient and case

  1. Name / Age / Sex
  2. UHID / IP no. / Ward-Bed
  3. Date of surgery / OT no.
  4. CaseElectiveEmergency (non-elective)if emergency, state urgency and reason
  5. Timesin OT ___ anaesthesia start ___ incision ___ closure ___ out of OT ___

Team

  1. Operating surgeonname, designation
  2. Assistant(s)
  3. Supervising consultantpresent in OT / available / not applicable
  4. Steps done by the residentwhole procedure / named steps, under whose supervision
  5. Anaesthetist
  6. Scrub nurse / circulating nurse

Diagnosis and procedure

  1. Pre-operative diagnosis
  2. Post-operative diagnosis
  3. Procedure planned
  4. Procedure performedif different from plan, state why
  5. Extra procedure done and reason'none' if none. Only to save life or health if not consented

Consent and safety checks

  1. Informed consentGeneralProcedure-specificHigh-riskAnaesthesiain a language the patient understands: language ___ witness ___
  2. Site / side markedYesNot applicable
  3. WHO Surgical Safety ChecklistSign inTime outSign out
  4. Antibiotic prophylaxisdrug, dose, route, time given before incision
  5. VTE prophylaxisMechanicalPharmacologicalNot indicated

Risks to explain in the consent for this operation

  • infection of the joint
  • bleeding into the joint (haemarthrosis), recurrent swelling
  • stiffness
  • damage to joint cartilage by instruments
  • injury to the saphenous or peroneal nerve, numbness near portals
  • deep vein thrombosis and pulmonary embolism
  • incomplete removal of the tear, recurrent tear
  • later arthritis after meniscus removal
  • fluid leak into the leg, rarely compartment syndrome

Pre-operative details for this operation

  1. SideRightLeftside confirmed with patient on the day and site marked
  2. Symptomslocking, giving way, recurrent swelling, duration; failed non-operative treatment
  3. MRI findingmeniscus, tear type, ligaments, cartilage
  4. X-rayarthritis present or not (standing views)
  5. Plan discussedMeniscectomyMeniscal repair if repairableDebridement / chondroplastyLoose body removalconsent covers repair and removal, and treatment of cartilage lesions found
  6. Equipment checked30 and 70 degree scopes, shaver, biters, graspers, pump, repair devices if repair possible

Anaesthesia and position

  1. AnaesthesiaSpinalGeneralSpinal with femoral / adductor canal block
  2. Examination under anaesthesiarange of motion, Lachman, anterior and posterior drawer, varus and valgus stress, pivot shift
  3. Leg supportThigh holderLateral postabout 10 cm above the upper pole of the patella
  4. TourniquetNot usedApplied, not inflatedInflatedpressure, time up and down
  5. InflowPumpGravitypump pressure

Operative findings

  1. Suprapatellar pouchadhesions, loose bodies, synovium
  2. Patellofemoral jointcartilage of patella and trochlea (grade), patellar tracking
  3. Medial and lateral guttersloose bodies, plica
  4. Medial compartmentfemoral condyle and tibial plateau cartilage (grade, size, site); medial meniscus: tear type, zone, length, stable or unstable on probing
  5. Intercondylar notchACL and PCL intact / torn / lax on probing
  6. Lateral compartmentcartilage; lateral meniscus; popliteus tendon and hiatus
  7. Posterior compartmentsseen with 70 degree scope / Gillquist view or not seen

Procedure (steps)

  1. Landmarks markedpatella, patellar tendon, joint lines
  2. Joint distensionnormal saline injected through needle (volume), or directly through the scope
  3. PortalsAnterolateral (viewing)Anteromedial (working)Superolateral (inflow / outflow)PosteromedialPosterolateralFar medial / far lateralCentral transpatellar1 cm stab with No. 11 blade; working portal localised with spinal needle under vision
  4. Systematic diagnostic arthroscopysuprapatellar pouch, patellofemoral joint, lateral gutter, medial gutter, medial compartment, notch, lateral compartment, posterior compartments; photographs taken
  5. Meniscal tear probedanterior and posterior extent, upper and lower surfaces, stability
  6. Procedure on meniscusPartial meniscectomySubtotal meniscectomyBucket-handle fragment excisedMeniscal repair (separate note)Not requiredinstruments used: basket, scissors, grasper, shaver, ablation device; amount removed; stable peripheral rim left (width)
  7. Other proceduresNoneChondroplasty of (site)Loose body removal (number, size)Plica excisionPartial synovectomy
  8. Final checkno loose fragments left in posterior compartment or under the meniscus; fluid sucked out

Closure, drains and dressing

  1. PortalsSimple interrupted non-absorbable monofilamentSteri-strips
  2. Local anaestheticintra-articular and portal infiltration: drug, dose
  3. Dressingcompression bandage toes to thigh
  4. Calf and thigh soft at endno fluid extravasation

Specimens and implants

  1. Meniscal fragment / loose bodyDiscardedSent for HPE
  2. SynoviumNot takenSent for HPE / culture
  3. Implantsnone for meniscectomy; for repair devices: type, number, lot, sticker
  4. Arthroscopy photographs savednumber

End of procedure

  1. Estimated blood lossml
  2. IV fluids and blood / products givenfluids (ml); blood: type, units, bag nos.
  3. Swab, needle and instrument countCorrectIncorrect: action taken
  4. Intra-operative complications / difficultieswhat happened and what was done; 'none' if none
  5. Implant stickersNo implantAffixed in case sheet, OT register and for discharge summary
  6. Condition at end of surgery / shifted toPACUWardICU/HDU

Post-operative orders

  1. Weight bearingfull weight bearing as tolerated with crutches as needed (after meniscectomy)
  2. Exercisesstraight-leg raising and active knee movement from day 0
  3. Cold therapy and elevation
  4. DVT preventionankle pumps, early walking, compression bandage; drug prophylaxis only if risk factors
  5. Analgesiadrug, dose, frequency
  6. Watch forfever, increasing swelling, calf pain
  7. Stitchesremoval date
  8. Follow-up and return to sportwhen full motion, no effusion and strength near the other side

Signature

  1. Name and designation of person writing note
  2. Medical Council registration no.
  3. Signature / date / time of writingwrite before the patient leaves recovery

Worked example

Fictional case: Mr. N.R., 27 years, footballer, twisting injury of the right knee 6 weeks ago, now locking twice a week. MRI: displaced bucket-handle tear of the medial meniscus, ACL intact. X-ray normal.

Case details

Date: 14/10/2026. Elective list. OT 5.

In OT 10:05. Spinal 10:12. Portals 10:30. End 11:15.

Surgeon: Dr A. (consultant). Assistant: Dr B. (2nd-year resident, Orthopaedics), who did the diagnostic arthroscopy.

Anaesthetist: Dr C. Scrub nurse: Sr D.

Indication and pre-op

Symptomatic displaced bucket-handle tear of the right medial meniscus with locking. Consent in Hindi for meniscal repair if the tear is repairable, or partial meniscectomy if not.

Right knee marked. WHO checklist done. No antibiotic prophylaxis (clean arthroscopy, no implant, as per unit policy).

Anaesthesia and position

Spinal anaesthesia. EUA: extension lacking 10 degrees, flexion 130 degrees, Lachman negative, stable to varus and valgus.

Supine. Right thigh in thigh holder 10 cm above patella, foot of table dropped. Left leg in padded well-leg holder. Tourniquet applied, not inflated.

Painted with povidone-iodine and draped. Landmarks marked. Pump inflow with normal saline.

Procedure

Anterolateral portal: 1 cm vertical stab with No. 11 blade, knee at 90 degrees. 30 degree scope inserted with blunt obturator. Anteromedial portal made under vision after spinal needle localisation.

Suprapatellar pouch: normal, no loose body. Patellofemoral joint: cartilage normal, tracking normal. Gutters: clear.

Medial compartment: bucket-handle tear of medial meniscus displaced into the notch, from posterior horn to body, about 3 cm. Fragment frayed and degenerate, not suitable for repair. Femoral condyle and tibial plateau cartilage normal.

Notch: ACL and PCL intact on probing. Lateral compartment: cartilage and lateral meniscus normal, popliteus normal.

Fragment reduced with probe. Posterior attachment almost fully cut with basket forceps under vision, small tag left. Anterior attachment cut flush with meniscal biter. Anteromedial portal enlarged with a haemostat. Fragment grasped, twisted and removed in one piece.

Remaining rim smoothed with 4.5 mm shaver. Stable peripheral rim of about 4 mm left. Probed: no residual unstable part. Posterior compartment checked: no loose fragment.

Knee extended fully at end. 6 photographs saved. Fluid sucked out.

Closure

Portals closed with simple interrupted polyamide (Ethilon) 3-0.

Compression bandage from toes to thigh. Calf and thigh soft.

Specimens and implants

Meniscal fragment 3 cm, discarded as human anatomical waste (yellow bag). No implants.

End of procedure

Blood loss minimal. Instrument count correct. No intra-operative complications.

Shifted to recovery, stable. Pulse 72/min, BP 120/70 mmHg.

Post-op orders

Full weight bearing as tolerated with crutches as needed, once spinal wears off.

Straight-leg raising, quadriceps setting and knee bending from today.

Ice packs and elevation. Ankle pumps.

Analgesia as per anaesthesia chart.

Report fever, increasing swelling or calf pain. Stitches out on day 10 to 14.

Signature

Dr B., JR-2, Orthopaedics, for Dr A. Reg. no. ________. 14/10/2026, 11:30.

Must document for this operation

  • Side, and that it was confirmed and marked. Both knees look alike under the drapes; the note shows the side check was done before the portals were made.
  • Findings in every compartment, including normal ones. A later surgeon (for example for ACL reconstruction or arthroplasty) relies on this as a baseline.
  • Tear type, site and why it was not repaired. Meniscus removal raises the risk of later arthritis; the reason for removal rather than repair should be clear.
  • Amount of meniscus removed and width of the rim left. Degenerative change is roughly in proportion to the amount removed; this matters for prognosis and future surgery.
  • Cartilage lesions with grade, size and site. Explains persistent pain after surgery and guides cartilage procedures later.
  • Tourniquet use and time, and state of the calf and thigh at the end. Fluid extravasation can cause compartment syndrome, and the record shows it was checked.

Common mistakes in these notes

  • Writing 'diagnostic arthroscopy normal' without listing the compartments seen.
  • Not stating the tear type and which horn was involved.
  • Not recording the amount of meniscus removed.
  • Leaving out cartilage grade because it was not the main problem.
  • No mention of photographs, which are useful for follow-up and audit.

Indian practice and paperwork

  • The removed meniscal fragment, if not sent for HPE, is human anatomical waste and goes in the yellow bag. (Bio-Medical Waste Management Rules 2016, DGHS/CPCB guidelines)
  • If a repair device or anchor is used, record its batch and serial number in the case sheet, implant logbook and discharge summary. (NABH Accreditation Standards for Hospitals, 5th ed. (2020), MOM.10(d))

Sources

  • Wiesel SW, Albert TJ, eds. Operative Techniques in Orthopaedic Surgery. 3rd ed. Vol 1. Wolters Kluwer; 2022, Sports Medicine ch 34, Knee arthroscopy: the basics (Hodax JD, Zhang AL, Allen CR), e-book PDF pp. 510-522.
  • Wiesel SW, Albert TJ, eds. Operative Techniques in Orthopaedic Surgery. 3rd ed. Vol 1. Wolters Kluwer; 2022, Sports Medicine ch 36, Arthroscopic meniscectomy (Azar FM, Smith PJ), e-book PDF pp. 546-554.
  • Saghieh S, et al., eds. Operative Dictations in Orthopedic Surgery. Springer; 2013, Ch 41, Arthroscopic meniscectomy of the knee (Sukkarieh HG), pp. 153-155.
  • Bratzler DW, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. Table 2: clean operations involving hand, knee or foot and not involving implantation of foreign materials: no prophylaxis recommended (strength of evidence C). academic.oup.com/ajhp/article/70/3/195/5112717

Educational template for residents. Adapt it to your institution's case-sheet format and your consultant's instructions. Patient details in the example are fictional.

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