Legal MDs Consulting Response:
Knee injuries are among the most common orthopedic complaints in personal injury and workers’ compensation cases. They also present recurring challenges in causation disputes, particularly when the plaintiff has any history of knee problems or when MRI findings show a mix of acute and chronic pathology. Our physician consultants regularly help attorneys navigate these complexities to ensure that knee injury damages are fully developed.
The anatomy of the knee makes it particularly vulnerable to traumatic injury. Lohmander et al. in the American Journal of Sports Medicine (2007, Volume 35, Issue 10, pages 1756–1769) conducted a systematic review demonstrating that anterior cruciate ligament (ACL) injuries and meniscal tears substantially increase the long-term risk of developing post-traumatic osteoarthritis, even after surgical repair. This finding has major implications for future medical damages: a 35-year-old who suffers an ACL tear in a motor vehicle accident faces a significantly elevated lifetime risk of knee arthritis, potential future knee replacement surgery, and years of ongoing pain management.
The challenge for attorneys is proving that the current knee pathology is causally related to the accident rather than being purely degenerative. Englund et al. in the New England Journal of Medicine (2008, Volume 359, Issue 11, pages 1108–1115) found that meniscal tears were present in 35% of individuals over age 50 on MRI, many of whom had no symptoms. As with spine cases, the presence of incidental findings on MRI does not negate the traumatic component when there is a documented mechanism of injury and a temporal relationship between the injury event and the onset of symptoms.
From a legal perspective, the concept of “acceleration of the natural degenerative process” is critical. In Smith v. Leech Brain & Co. Ltd. [1962] 2 QB 405, the court established that a tortfeasor who accelerates the onset of a condition that might have occurred naturally at some future point is liable for the damages caused by that acceleration. Applied to knee cases, this means that if a traumatic event caused an arthritic knee to require replacement surgery five or ten years earlier than it otherwise would have, the defendant bears responsibility for those accelerated damages.
We recently reviewed a case involving a 48-year-old postal carrier who slipped on an icy sidewalk and sustained a complex meniscal tear. The defense argued that the MRI showed degenerative changes and that the tear was not related to the fall. We reviewed the pre-accident medical records and found that the client had no prior knee complaints and had passed the postal service’s physical fitness requirements six months before the incident. We obtained the original MRI images and had them reviewed by a musculoskeletal radiologist who identified an acute component to the meniscal tear based on the signal characteristics and tear morphology. Our report, supported by the Englund and Lohmander data, established that the fall caused an acute traumatic tear superimposed on age-appropriate degenerative changes, and projected future care costs including the likelihood of eventual total knee arthroplasty.
When your client has a knee injury case, our physician consultants can help distinguish acute traumatic pathology from pre-existing degenerative changes, project the long-term consequences of the injury based on the current orthopedic literature, and build a medical foundation for full damages recovery.
References
Lohmander LS, Englund PM, Dahl LL, et al. “The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis.” American Journal of Sports Medicine. 2007;35(10):1756-1769.
Englund M, Guermazi A, Gale D, et al. “Incidental meniscal findings on knee MRI in middle-aged and elderly persons.” New England Journal of Medicine. 2008;359(11):1108-1115.
Smith v. Leech Brain & Co. Ltd. [1962] 2 QB 405.
This situation is another example of how we can assist you with all the medical issues in your cases. Call (954) 649-5739 or email DrC@legalmds.com to schedule a time to talk about one of your cases.
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