Defense Verdict in a Case of Arthroscopic Surgery with Ligament Reconstruction
PRI obtained a defense verdict on behalf of an orthopedic surgeon in a case involving an allegation of negligent performance of an arthroscopic surgery with anterior cruciate ligament reconstruction on a 40-year old construction worker.
The events of the case began on April 20th, when the patient injured his right knee while playing football with friends. The patient went to the emergency department where his was placed in a knee immobilizer and was instructed to follow up with an orthopedic surgeon. Three days later, the patient was seen by the defendant orthopedic surgeon. An MRI was performed showing non-displaced fractures involving the posterior margin of the medial and lateral tibial plateaus with a complete ACL tear.
The patient went to physical therapy for the next few weeks and 2 months from the date of initial injury, the defendant orthopedic surgeon performed an arthroscopic surgery with ACL reconstruction. Following the surgery, the patient continued to complain of pain. One and a half years after the surgery, the patient went to a different surgeon. The surgeon told the patient that the graft from the prior surgery was placed “too vertical”, causing rotational instability. Almost 2 years after the original surgery, the second orthopedic surgeon operated on the patient’s knee, removing the first graft and placing a new graft “in a completely different area from the previously placed graft”. A repair of the medial meniscus was also performed. After the second operation, the patient claimed to have improved symptoms and he sued the first orthopedic surgeon, alleging that the original graft was improperly placed, leading to pain, disability, and the need for repeated surgery.
During trial the plaintiff’s attorney tried to show that the defendant misplaced the graft and then minimized the patient’s complaints following the surgery. Plaintiff’s counsel tried to prove that the x-ray that was performed following the surgery did not optimally show the positioning of the graft and pointed to the defendant’s operating report which did not specifically state the orientation of the graft. The plaintiff’s attorney used the findings and report of the second orthopedic surgeon as a form of expert witness against our insured and produced an expert in orthopedic surgery to support the claim that the orthopedic surgeon used improper surgical technique.
In defense of our orthopedic surgeon, PRI was able to show that the original surgery was properly performed. Defense counsel demonstrated that the femoral tunnel was clearly demonstrated to be at about 10:30 orientation which is within the appropriate standard, and that it is not necessary to obtain a post-operative MRI to visualize the orientation of the tendon itself, as was alleged by the plaintiff’s attorney. Furthermore, the defense showed that the patient had been examined by multiple clinicians following the surgery and no evidence of instability was found. The defense then showed that the reason for the patient’s pain at the visit with the second orthopedic surgeon was that the patient has a tear of the medial meniscus. The MRI ordered by the second orthopedic surgeon as well as the second orthopedist’s intro-operative report both showed that the original ACL graft was intact. Had the second surgeon merely attended to the meniscal tear, rather than perform a whole revision of the graft, the patient would have had a similar outcome. Finally, the defense showed that the patient was often non-compliant with physical therapy and follow-up care and therefore contributed to his suboptimal outcome. PRI produced an orthopedic surgeon with subspecialty expertise who was able to fully support the quality of care provided by our insured orthopedist. After hearing both sides of the case, the jury determined that our insured did not depart from the standard of care, and a defense verdict was obtained.