03/04/2016    

Grand Rounds Second Opinion Service

Last year, I performed a posterior tibial tendon
reconstruction on a patient who had recalcitrant
posterior tibial tendonitis associated with a
flat foot (PTTD). Prior to the surgery, she
exhausted PT and was non-weight-bearing for
episodic periods. When I initially saw her, she
was in peroneal spasm but after a common peroneal
block the STJ had about 30 degrees of motion. I
visualized this with a mini “C” arm.

I ultimately did a PTT advancement and used a
tendon anchor to re-attach the tendon. Prior to
the surgery we discussed the options of flat foot
reconstruction vs repair the tendon and use a
brace or orthoses. We opted for a tendon
reconstruction and to avoid joint fusions at this
time (30 y/o). The patient had some post
operative edema and went to PT for several months
where STJ ROM was again documented as inversion
of 18 degrees and eversion of 8 degrees.

The patient requested a second opinion and
requested that records be sent to “grand rounds”
which is a second opinion service out of San Francisco, CA
in which the physician reviews records and gives
an opinion without examination. I received a
copy of the second opinion today and it stated
that the patient must have a talo calcaneal
coalition—which was not diagnosed in a MRI scan
taken. It stated that it was the reviewing
physicians opinion that I performed the wrong
surgery based on an incorrect diagnosis and that
she would need further surgery with a personal
recommendation by the reviewing physician that
the patient not return to me as her surgeon
because it was his opinion that the surgery was
mishandled.

I don’t know what this person based his
diagnosis and conclusions on without being able
to evaluate the STJ ROM. This patient had a STJ
with a reasonable ROM. She had no typical talar
bossing and the MRI report mentioned nothing of a
coalition. Has anyone else gotten a second
opinion from this service? The reviewer was an
orthopedic foot surgeon in San Francisco, CA..

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