Orthopedic Surgeon’s Repair of Tendon Leads to Synovitis

This case involves a thirty-four-year-old female who presented to the emergency room after falling from six feet in the air. She was first diagnosed with an injury to her anterior talofibular ligament with no fracture evident on initial imaging. Her ankle was being treated conservatively and was not getting better after some time. The patient then began seeing an orthopedic surgeon who said that her MRI showed a tear to the peroneus brevis tendon and suggested surgical intervention. The orthopedic surgeon performed a peroneus brevis stripping but found no evidence of a tear during the procedure and diagnosed her with peroneal tenosynovitis. During a follow-up, the surgeon advised the patient to bear full weight on the afflicted limb but did not suggest any bracing. At this point, the patient suffered from worse pain that prompted her to see another doctor that performed a left ankle arthroscopic debridement and an open left ankle repair. The patient was ultimately diagnosed with severe synovitis of an infectious etiology and could no longer bear weight on the afflicted limb.

Question(s) For Expert Witness

1. Was the standard of care offered to this patient when she first presented to the orthopedic surgeon?

Expert Witness Response E-001037

The primary indication for treating these disorders is pain. Nonsurgical treatment usually is attempted first. Failure of conservative measures is an indication for operative intervention. If the patient had an infectious etiology that went unnoticed for an extensive period of time and was the proximate cause of the tissue injury due to the debridement, then this case may have merit. Natural immune response mechanisms cause swelling and migration of inflammatory cells, mediators. The septic process, along with the inflammatory reaction, could cause extensive tendon sheath adhesions and scarring.