Failed Lateral Release Surgery

[Ansgar]

I laterally dislocated my left patella in march of 2005 from a plant and twist injury. The knee was reduced at the hospital immediatly after the injury. Everything healed well aftter the injury, the only problem was intermittent medial patella femoral joint line pain. I had seen 3 different specialists and one orthopedic surgeon at a sports medicine clinic from Jan. 2007- Dec. 2009. I had several appointments with each specialist and surgeon over this span of time and each time I complained of medial patella femoral joinline pain and medial plica pain. At each appointment with each specialist, I was very specific and detailed each time of my symptoms and where the pain was and my complaints were acknowleged each time. An MRI was also conducted after the first appointment which showed "normal".

I had my final appointment with my surgeon in Dec. 2009 where I explicitly discussed my medial patella femoral jointline pain and medial plica pain and was very detailed and technical in describing my problem and the symptoms. I asked the surgeon if he believed the crux of my problem is the medial plica band and he agreed that this was the crux of my problem and source of my pain. Another thing I asked him is if he would be able to thouroughly explore the medial patella femoral jointline with his scope because I believed that in addition to the medial plica band, there may be a bone spur protruding from the medial articulating cartilage surface of the patella which was gouging the medial femoral condyle during articulation of the knee cap. He assured me that he would be able to inspect the entire area and clean up any problems in that specific area. I also asked him if it would be more logical to manage my pain with pain killers or to try to aleiviate the pain through surgery and he believed that surgery was the more logical option. A LATERAL RELEASE was never discussed, only breifly mentioned by the surgeon for a few seconds during the appointment and he was passive about it. I once again asked him if we would be able to inspect the medial jointline first and foremost and he said yes.

In april 2010, I had the surgery. He ended up doing the LATERAL RELEASE FIRST(3 inch cut), then ended up SHAVING MY LATERAL MENISCUS, and lastly he cleaned up the medial plica band as it was scared and damaged(the part I asked for and the part the surgeon agreed was the focal point and the source of the problem and surgery).

It is now just over 5 months after the surgery and my knee is expontentially worse pain wise and went from perfect functionality with only medial plica pain(which was proven on the surgery), to horrible knee pain and dysfunction. I can barely get around the house and walk with a bad limp and have pain in my quadricep, all behind the knee cap, and lateral meniscus. I spend most of my time laying in bed but still do my physio exercises as prescribed but the knee just feels awful and functions poorly despite the efforts to strengthen it. There is still swelling around the knee as well.

I thought this surgeon was going to go in for a simple clean up of the medial plica band and bone spur and he ends up butchering my leg with a 3inch gash lateral release and lateral meniscus shaving(which wasnt discussed and was asymptomatic). He also tells me now that he wouldnt shave a bone spur on the knee cap since it could grow back larger and worse. WHY DIDNT HE SAY THIS BEFORE THE SURGERY WHEN WE DISCUSSED IT?

How can a surgeon be so incompetent to tell a patient that the crux of their problem is a medial plica band and then make the main focus of the surgery a 3 inch gash lateral release and shaving of the lateral meniscus? Isnt it illegal to lie like that and do the complete opposite of what the patient asked and what was agreed to?

Can I get any compinsation from this surgeon because to me it seems he screwed up royally and now I cant even walk where before I could play sports and be active, my only problem was the intermitent medial jointline pain.

Any help or advice is appreciated.

Tom  

[Barric]

You have far more technical knowledge about the knee than I do, I guess because you are living with it. So, all I can do is provide general legal answers. Firstly, I am sure that it is far more difficult to sue a surgeon in Canada than in the US. I'm not sure the law even permits it in Canada short of evidence of gross negligence or serious malfeasance(ie: drunk surgery, etc.).  In the US, medical malpractice requires qualified expert testimony(ie,in your case, from an orthopedic surgeon)that the surgery was done BELOW THE STANDARD OF CARE(magic legal words).  But a poor result is not evidence of a breach in that standard. Different surgeons can approach a surgery in different ways. As long as they used "reasonable medical judgment", by definition there was no malpractice even if the patient had a terrible outcome. In your case, I actually think you got too involved in your own surgery. The surgeon even told you that they have to get into the knee and then make final decisions as to what needed repair, and how. Clinical exam and MRI are very important of course but direct visualization is the gold standard. So, he went in there and did what he thought would help you. Even if he was wrong, again, that isn't malpractice, necessarily. In the US, an analogy would be this: imagine a current medical textbook considered the gold standard by all ortho surgeons.  There is a chapter on how to deal with a case just like yours.  Undoubtedly it will give different possible approaches. But to be malpractice, your surgeon must have done something that the book says explicitly NOT TO DO or he failed to do something that the book says MUST BE DONE.  In other words, there was a blatant failure to follow the standard guidelines(standard of care).  I doubt that your surgeon was guilty of this. Before you give more thought to suing your surgeon, just do a little legal research. Simply google "medical malpractice Canada". It will probably tell you to forget the idea. Concentrate on finding another surgeon who can solve your problem. Good luck