PLEASE REPLY ONLY IF YOU SPECIALIZE IN FOOT AND ANKLE ORTHOPEDIC SURGERY.
In March, 2024, a 19 y/o male underwent L ankle surgery due to left ankle injury/fracture. Left ankle arthroscopy was performed with removal of multiple loose bodies, exostectomy of tibia/fibula, and lateral ligament repair.
He later developed ankle impingement/internal derangement and on 7.17.2025, underwent left ankle arthroscopy. During the surgery anterior medial port was placed and diagnostic arthroscopy was performed which revealed left ankle joint scarring and synovitis throughout the anterior ankle joint. Lateral port was placed and extensive debridement of scar tissue was performed. Port sites were closed, leg was placed in ACE wrap.
He presented to the Hospital on 8.29.2025 due to left ankle pain, swelling and difficulty walking. MRI showed 3.4cm anterior tibial pseudoaneurysm. He was evaluated by interventional radiology and deemed not a candidate for endovascular intervention given size and location of pseudoaneurysm. Vascular surgery was consulted. 9.2.2025 he was taken to the OR for surgical repair, thrombectomy, and ligation of anterior tibial artery. Was the type of surgery undertaken in July 2025 appropriate and indicated. Was the pseudoaneurysm the result of surgical injury and did that fall below standard of care.
Files:
Q: Was this potential complication disclosed to the patient before surgery? What portal for the ankle arthroscopy were used? What is the ultimate patient outcome.
A: —
Do you believe there might have been medical error?
The anterior tibial artery travels anterior to the ankle joint capsule. The anteromedial and anterolateral arthroscopy portals are carefully placed medial and lateral to the anterior tibial artery, respectively. During anterior ankle joint synovectomy and debridement, it is imperative to be careful not to debride/dissect too anteriorly or the artery can be injured. In this case, the anterior tibial artery was most likely damaged by the arthroscopic shaver leading to the pseudo aneurysm. I have never seen this complication in any of my patients over the last 11 years and have only seen the complication once in an arthroscopy performed by another local surgeon.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
As above, damage to the anterior tibial artery during the arthroscopic debridement most likely led to the pseudo aneurysm.
What makes you a good expert for this case?
I am an experienced orthopedic foot and ankle surgeon who has been in full time practice since 2015 and I have significant experience reviewing medical malpractice cases as an expert.
How often do you encounter cases similar to this one in your practice?
I perform ankle arthroscopy procedures weekly. As above, I have never seen this complication in my patients and have only seen it happen once after an ankle arthroscopy performed by another surgeon.
Do you believe there might have been medical error?
An anterior tibial artery injury is quite rare, in a recent article looking at complications of ankle arthroscopy there were injuries to nerves but no injuries to to the anterior tibial artery. There is a case report though of two anterior tibial artery injuries both in patients with hemophelia.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The injury was associated with the ankle arthroscopy, that is what must have injured the anterior tibial artery. The summary did not indicate what portal were used. The summary provided did not indicate if this potential complication was disclosed to the patient before he underwent elective surgery. There were not images of the ankle before or after fixation so it is difficult to assess how severe the initial injury was. These would have a bearing on the ultimate success of the case at trial. I can also surmise what the defense will come back with if the suit goes forward. Also what the ultimate patient outcome will be important do decide if proceeding.
What makes you a good expert for this case?
I am an orthopaedic trauma surgeon and fix many ankle fractures. Although IU do ankle arthroscopy, I only do it as a small part of my practice. I would be able to find you a better expert than myself if you wanted a full review. Best, Romney
How often do you encounter cases similar to this one in your practice?
Never, this is an incredibly rare complication with well less than a 1% incidence, potentially 0.1% incidence.
Do you believe there might have been medical error?
It appears based on the information that during the procedure either a portal or by using the scope or shaver there was damage done to the artery. This is a rare complication but should be dealt with once identified.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
If possible complications and risks of the procedure were not clearly discussed with the patient prior to surgery. Also if a thorough exam and identification of the pulse on the ankle was not identified prior to surgery to be sure to give the least amount of risk of damaging the artery.
What makes you a good expert for this case?
I have been in practice as a general orthopedic surgeon for over 25 years.
How often do you encounter cases similar to this one in your practice?
I have not encountered this issue in practice.
Do you believe there might have been medical error?
The vascular injury after ankle scope is unusual but a recognized complication. I would NOT consider this a deviation from the standard of care and would not recommend Plaintiff action. Damages will be limited even if a jury could be swayed. This is a case I would be happy to defend.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
The ankle scope caused the vascular injury but this complication is a recognized risk, even more so after research documented some patients are at increased anatomic risk.
What makes you a good expert for this case?
I have extensive experience in ankle arthroscopy and have treated many complications. As an academic subspecialist, I teach and write about ankle surgery. I am very familiar with the standards of care in this area of medicine.
How often do you encounter cases similar to this one in your practice?
I have not seen arterial injury but have seen many nerve injuries from ankle arthroscopy, the more common complication.
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