Dr. Brian Gruber 2014-06-03 03:14:49
Is it Pre-existing? A torn meniscus is one of the most common knee injuries. Any activity or accident that causes you to forcefully twist or rotate your knee, especially when putting the pressure of your full weight on it, can lead to a torn meniscus. Each of your knees has two menisci, a C-shaped piece of cartilage that act like a cushion between your shinbone and your thighbone. A torn meniscus causes pain, swelling and stiffness. You also might have trouble extending your knee fully. The meniscal cartilage is distinct from articular cartilage. Articular cartilage covers the ends of the bones. This is the cartilage that may degenerate and result in a knee replacement. Meniscal tears can be acute or chronic. When litigation is involved the acuity of the injury is typically in question. This article will dissect a scenario, describing the causal relationship within reasonable medical probability. KNEE INJURY CASE A 58-year-old obese female driver was rear-ended at a low rate of speed (5mph). Claimant notes she hit her right knee on the steering column. Claimant complains of right knee pain a few days later. She denies any previous right knee pain. She is seen by an orthopedic surgeon and X-rays show no fracture, however, they do show arthritis. MRI is subsequently obtained and the report shows significant arthritis throughout the knee as well as degenerative meniscal tears. WHAT WOULD BE THE TRADITIONAL TREATMENT FOR THIS KNEE INJURY? The degenerative knee is typically treated initially with conservative care. NSAIDs (Motrin), physical therapy, and steroid injections are typical mainstays of treatment. Each situation is obviously different, but the acute exacerbation of a degenerative knee can typically be settled down in 4-6 weeks. IS SURGERY EVER REQUIRED FOR THIS TYPE OF KNEE INJURY? Yes. If the surgeon is unable to resolve the knee pain, then surgical intervention is considered. This also is determined by specific symptoms. For example, when the meniscus tears, there can be loose pieces that can cause locking, catching and the inability to straighten or bend the knee. These are mechanical symptoms and may require surgery. IN THIS CASE DID THE ACCIDENT CAUSE THE ARTHRITIS OR MENISCAL TEARS? No. First, the mechanism is not consistent. The meniscus is usually torn when pressure is applied through the knee and there is a twist. A low-velocity, rear-end accident typically would not cause a meniscal tear. The meniscal tears described in this scenario are under a setting of preexisting degeneration of the knee. The claimant has arthritis and probably had the meniscal tears prior to the accident. These two processes (degenerative meniscal tears and arthritis) can be present in the knee and the patient has no symptoms. The accident may have exacerbated the pre-existing arthritis and the aforementioned claimant may indeed have true knee pain related to the accident, however, the accident did not directly cause the arthritis or meniscal pathology. Dr. Brian Gruber is a board certified orthopedic doctor who specializes in arthroscopic surgery of the shoulder and knee. Gruber obtained his undergraduate degree at Newman University in Kansas where he was also an academic All-American in baseball, Gruber went on to graduate with honors from the University of Illinois - Chicago. Gruber completed an orthopedic surgery residency at the University of Michigan Hospital and Health System in Ann Arbor, Michigan, and then completed his orthopedic and sports medicine training at Washington University. Gruber recently graduated with his MBA from the University of Southern California in June 2013. For more information please call ExamWorks at (866) 800-4637.
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