Note #1:

Subjective:
Mr. XXXX is a XX-year-old male who presents today for evaluation of bilateral knee pain. He states that
the location and laterality of his knee pain depends on the day and is intermittent in nature. He states that
squatting, kneeling and walking are all bothersome. This has been going on for approximately a couple of
years with no associated injury reported prior to onset. He is having some pain medially, anteriorly, and
posteriorly. He denies locking and catching but admits bilateral knee buckling. It is no more bothersome
than usual when he is going up and down stairs. He does also report some mild low back pain and hip pain
localized across the top of the iliac crest. He has been doing some light strengthening exercises. His pain
has not improved over time, though he is unsure if it has worsened. He denies any sharp or stabbing pains
with turning or twisting movements. He has not tried treating with any medications.

ROS:
***insert ortho ROS with bilateral knee pain with some mild lower back pain.***
***Insert template for knee exam***
He is ambulating well today without any assistance. Bilateral knee exam reveals normal findings except for
some pain with patellar compression and crepitus on the patella. He does have mild tenderness along the
medial joint line with mild positive circumduction test. Lachman and anterior drawer are both negative. He
has full extension of both knees with flexion to 130 degrees, no pain with full flexion. No effusion and no
lateral tenderness with no varus or valgus opening. Sensation is intact throughout.

Results:
Radiographs were ordered of the bilateral knee and on my independent review of visualization note there
were no osseous abnormalities. No joint space narrowing. No evidence of acute findings. X-rays were
normal. No evidence of injury.

Assessment and Plan:

1. Bilateral patellofemoral knee pain.
Radiographs of the bilateral knee and on my independent review and visualization note no osseous
abnormalities. No obvious or acute findings noted on X-ray imaging, but his symptoms appear to be
primarily patellofemoral. We discussed treatment options including more aggressive targeting of the
quads, and exercises were provided reviewed with the patient today. Aleve and ibuprofen as needed. He
will avoid injections for now. Follow up with me in 6 weeks to reassess, and we will consider MRI
imaging at that time if there is no improvement. All of his questions were answered to his satisfaction, and
he was in agreement with the plan.

Note #2:

Subjective:
Ms. XXXX is a XX-year-old female who presents today at the request of Dr. XXXX for evaluation of
right knee pain. She reports right knee pain and intermittent grinding which began 4 to 5 months ago with
no known associated trauma or injury. She denies locking or catching, but admits frequent popping as
though it is coming out of place. She notes that she tends to have mild anterior swelling to both knees,
however she believes this is due to arthritis and not a new or exacerbated symptom. She specifically
mentions patellofemoral soreness, although she denies pain or difficulty with getting up out of a chair or
going up and down stairs. She states she is unable to take NSAIDs due to anticoagulant use for atrial
fibrillation followed by subsequent WATCHMAN device placement. She does take Tylenol currently. She
denies any concerns with the left knee. She also reports low back pain due to arthritis. She denies
numbness or tingling into her feet, although she does note a sharp pain radiating into her left leg. She does
have some pain upon standing, and she mentions that she feels she is "listing" to the left recently.
ROS:
***Insert ortho review of systems, pre-templated with joint pain and lower back pain***
Physical Exam:
***Insert normal exam for the knee***
She is ambulating well today with use of a cane for assistance.
She has decreased flexion and extension of the lumbar spine, which does elicit some pain, but negative
straight leg raise. On exam of her right knee, she has full extension with flexion to 120 degrees, but does
have tenderness along the medial joint line. Some pain with patellar compression with a mild positive
circumduction test with no varus or valgus opening and negative Lachman and anterior drawer with
minimal effusion. Left knee with full range of motion and no tenderness.
Results:
Radiographs were ordered of the right knee by Dr. XXXX and on my independent review of visualization
note degenerative changes in the medial side of the right knee with joint space narrowing and subchondral
sclerosis.
Assessment and Plan:
1. Arthritis of the patellofemoral and medial joint.
Given this patient's history, physical examination, and imaging studies, the suspected diagnosis is primary
osteoarthritis of the right knee. Although imaging reveals arthritis medially, her pain is primarily
patellofemoral in nature. We discussed that quad exercises in particular can help mitigate stress on the
patella and she was provided exercises to begin at home. Weight loss is also encouraged to relieve stress to
the knee. She is limited with medications she can use, so we did discuss both cortisone and
viscosupplementation injections, and we will proceed with a right knee cortisone injection today. This may
be repeated up to 3 times per year. If she finds this is ineffective or wearing off too quickly, we can further
consider viscosupplementation series. She will begin home exercises and follow up with me in 5 weeks to
assess her response to the cortisone injection. She is in agreement with the above plan. She was given the
opportunity to ask questions with regards to the above proposed treatment plan.
***Insert injection for the large joint template for right knee***

Note #3:

Subjective:
***insert TMF ambulatory orthopedic progress note template***
Consulting Provider is Dr. XXXX.
Mr. XXXX is a XX-year-old male who presents today for evaluation of bilateral knee pain. He states that
he has previously discussed this with Dr. XXXX, who is now on long-term medical leave. He was instead
seen by Dr. XXXX with complaints of continued knee pain, and MRI imaging was ordered. He notes that
his left knee is more bothersome than the right knee and he has been having this bilateral knee pain
intermittently for a very long time. He states that he was not able to walk after getting the COVID-19
vaccination. His first vaccine was in 02/21/2022. Then when he asked for the MRI, both his knees were
very painful, but his pain has subsided. He reports that he is having trouble walking up the stairs. He
admits to having occasional catching and popping in his knee. He reports that he did have a painful pop in
his knee 2 to 3 years ago while kneeling and it was painful, though he denies pain currently with popping
specifically. He states that he was playing hockey into his 40s. He was also playing football in his
backyard. He notes that he injured his knee when he was playing racquetball about 30 years ago and was
limping for about a month after the incident. He reports that he used to do exercises including the
treadmill. He used to do plank for 2 minutes with 20 pushups every morning 5 days a week. He is not able
to localize the pain. He denies any swelling. He denies any back or hip pain. He denies taking any
ibuprofen or Aleve. He denies any numbness or tingling.
Physical Exam:
Slight varus alignment on the knees. He has a normal gait. He is able to easily stand from a seated position.
Lumbar spine nontender. Negative straight leg raise. Flexion of both hips to 110 degrees of full extension.
Full internal and external rotation without pain. Bilateral knees with varus alignment and tenderness along
the medial joint line. Negative circumduction test and McMurray's sign to both knees. Full extension of
both knees with flexion to 120 degrees. Minimal pain with patellar compression and slight crepitus on the
patella with knee flexion and extension, mild effusion. He has strength 5 out of 5 with ankle dorsiflexion,
plantar flexion as well as knee flexion and extension and sensation to light touch intact throughout both
lower extremities with skin clean, dry and intact and 2+ dorsalis pedis and posterior tibial pulses.
Results:
Radiographs were ordered for bilateral knee and on my independent review and visualization note end-
stage degenerative changes of the medial compartment of the right knee with joint space narrowing to bone
on bone contact, subchondral sclerosis and periarticular osteophyte formation. Left knee with very mild
degenerative changes in the medial compartment. MRI that the patient brought with him today on an
independent review and visualization noted complex tear of the medial meniscus with mild
chondromalacia of the medial compartment.
Assessment and Plan:
Bilateral knee pain.
Patient with osteoarthritis of the right knee and medial meniscal tear of the left knee based on radiographs
as interpreted. He has bone on bone narrowing. His left knee does not have any significant arthritis;
however, he has mild narrowing at the medial side. I informed him that some of the COVID-19 boosters
can flare up the generalized inflammation. On visualization of the MRI, he has a meniscal tear on the left
side, which is the reason for his intermittent sharp stabbing pain on the medial side of his knee. I informed
him that this issue can be addressed arthroscopically should it become more bothersome. With regard to
the right knee, the only surgical option at this point would be arthroplasty, although we may be able to
address inflammation and pain with cortisone injections. Plan is for quadriceps exercises and anti-
inflammatories as needed. Weight loss is also encouraged to relieve stress to the knee. Radiograph results
were also discussed with the patient. Activities as tolerated and discussed some exercises that he may be
able to do at home as well as activity modifications to avoid aggravating his knees and he will contact me
if he has further problems.