Summary
Successful recovery of damages following a delay in diagnosing and treating a complex sports injury resulting in more extensive and additional surgery and prolonged recovery period.
Settlement
£23,000 to a young man following a delay in diagnosing and treating a football injury.
What Happened
The Claimant was a young, keen sportsman who sustained a football injury to the knee and lower leg causing partial weight-bearing and severe pain for which he sought medical assistance from A&E at the end of March 2019. No investigations were completed prior to the Claimant being discharged.
The following day he developed further swelling, bruising and pain and therefore attended an urgent care centre where he underwent an x-ray. “No bone injury” was reported.
The Claimant continued to suffer and was deemed unfit to work. He was referred to the musculo-skeletal service on 23.04.2019 and assessed by a Physiotherapist on 04.06.2019. The knee symptoms were unchanged and the Claimant was recommended treatment for education of knee ligament damage, MRI and potential for surgery.
On 29.06.2019 the MRI revealed a severe injury in the right knee with severe partial tears of the anterior cruciate ligament, scarring and degeneration to the ACL and posterior cruciate ligament superior insertion. There was a severe injury to the postero-lateral corner with a tear of the lateral collateral ligament at its fibular attachment, partial tear of the biceps femoris tendon and a tear of the popliteal fibular ligament and arcuate ligament. There was a partial tear of the posterior aspect of the iliotibial band which required further CT evaluation. There was also a grade 2 sprain with partial tear of the popliteus tendon. Follow up was marked as urgent.
The Claimant saw a Consultant on 31.07.2019. He needed a multi-ligament knee reconstruction and was placed on the waiting list for osteotomy surgery of the right tibia which was to be followed, in a second procedure, by PLC and ACL repair.
On 23.09.2019 the Claimant underwent a diagnostic arthroscopy right knee and high tibial osteotomy right knee. An unlocked hinge knee brace was to remain for six weeks, 24 hours a day, apart from when washing and that the Claimant could mobilise fully weight-bearing in a brace.
By 16.01.2020 the Claimant was noted to have an excellent range of movement in the right knee but that the anterior cruciate and lateral collateral ligaments were lax. As such he was referred for further surgery in April 2020 however this was delayed due to the Covid 19 pandemic.
On 01.12.2020 the Claimant underwent further surgery in the form of a right posterior lateral corner reconstruction with semitendinosus., following which he made a good recovery.
The claim was advanced on the basis that; had the diagnosis been made earlier and had the surgery not been delayed, the Claimant would have only required one surgery, would have avoided the high tibial osteotomy procedure and would have been recovered within three months (around July 2019). Instead, the Claimant did not recover until around 1 March 2021, being an avoidable delay of one year and seven months.
Condition and Prognosis evidence was obtained from a Consultant Orthopaedic surgeon specialising in lower limb surgery. He opined that:
“….but for the delay in diagnosis, a similar result would have been achieved but with only one surgical procedure and with less pain, suffering and work disruption. …The delay in diagnosis has caused the need for two surgical procedures instead of one, and a prolonged period of pain, suffering and work disruption but not impacted on the long-term prognosis”. The Claimant was noted to have a small increased risk of developing degenerative change later in life.
The Defendant Trust was notified of the injuries and allegations as set out in a Letter of Claim. Within the body of the Defendant’s Letter of Response they accepted that the treatment received in A&E fell below the reasonable standard expected in that there was a failure to take an adequate examination/history of the injury and a failure to refer to orthopaedics.
Further, the Defendant accepted that, but for the breaches, the Claimant would have been seen by orthopaedics and diagnosed within 2 weeks of the injury and undergone an acute posterolateral corner repair within 1-2 weeks of diagnosis.
In light of the admissions a modest schedule of loss was compiled and served upon the Defendant along side a Part 36 settlement proposal to commence settlement negotiations.
Discussions ensued between the parties and the claim was concluded at £23,000 which was predominantly made up of PSLA (pain, suffering and loss of amenity).
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