A history as to this claim for compensation might provide a helpful backdrop to a brief summary of the testimony of the numerous witnesses called by the employee and employer. Mr. John Hoff alleges to have suffered a right knee injury at work on July 26, 2000, while performing his duties as a maintenance man for the St. Clair School District. Claimant relates that he got one of his shoelaces trapped under a door while entering one of the school buildings, causing him to fall onto his right knee. Claimant immediately advised his supervisor of the injury, but did not seek medical treatment until July 31, 2000, when he was referred to Dr. Bonney at Urgicare (Urgicare records contained within Claimant’s Exhibit P).
Claimant was diagnosed as having a right ankle sprain and an abrasion/contusion of the right knee. Dr. Bonney placed the right ankle in an air cast splint, and allowed the claimant to return to work the following day. Claimant continued to work, and did not seek any further treatment until a return to Dr. Bonney on 9/18/00. At his second visit to Dr. Bonney, Mr. Hoff complained of pain going up and down steps, and of a locking sensation in the medial knee. Claimant was referred to Dr. Nogalski for an orthopedic evaluation for what Dr. Bonney supposed was a probable medial meniscus tear of the right knee.
On 9/25/00 Dr. Nogalski documented the following history in his letter to Gallagher Bassett dated 9/25/00 (See Claimant's Exhibit P, the records of Dr. Nogalski):
He caught his shoestring while walking through a doorway and twisted his right knee awkwardly. He has had continued soreness and pain in the right knee with some swelling. He has had episodes in which his knee has caught and he has fallen down. He has continued to work at full duty. He states he fell at work last week and scraped both elbows because of this....
Dr. Nogalski examined the knee, noted effusion and tenderness along the medial joint line, and ordered an MRI for a suspected torn medial meniscus. Claimant went so far as to have an initial consultation for physical therapy at St. John's in Washington, Missouri relative to the suspected meniscus tear, when the results of the MRI taken on 9/27/00 (See Exhibit 9 to the deposition of Dr. Hertel, Claimant's Exhibit F) revealed "Posterior cruciate ligament tear with apparent detachment of the cruciate ligament from it's insertion into the posterior central tibia". Dr. Nogalski performed a follow up evaluation on 10/16/00. Physical therapy records dated 9/27/00 indicate "Patient's right knee appears to be extremely edematous compared to the left...". A physical therapy record dated 10/6/00 suggests that observation revealed moderate to severe edema of the right knee. Claimant appears to have attended as many as six physical therapy sessions through 10/6/00.
On 10/6/00 Dr. Nogalski concluded that the claimant suffered from a tear of the pcl; chose to treat nonoperatively; and recommended a continued strengthening treatment at home. He further declined to recommend the use of a pcl brace; recommended a return to full duty; and released Mr. Hoff from his care.
Claimant continued to suffer giving way of his knee, to the point that he chose to take his four- prong cane to work to provide for protection against instability of the knee. The employer declined to have the claimant at work sporting a cane, and on 11/6/00 the claimant was referred to Dr. Nogalski for further evaluation. Dr. Nogalski noted similar findings as in his prior exam on 10/6/00, save for a lump in the pretibial region believed to be new. He concluded that claimant would be capable of an attempt to return to full duties with respect to the knee, noting that "other issues" might cause problems.
Claimant then chose to get a second opinion from Dr. Thomas Matthews. Claimant had a prior history of treatment with Dr. Matthews, who in December of 1999 had provided claimant with a corticosteroid injection to take care of complaints relative to the left knee. Dr. Matthews had also been treating Mr. Hoff for fracture to his left wrist suffered as a consequence of falling at home after having had a seizure in June of 2000.
On 11/14/00 Dr. Matthews performed an evaluation of the right knee; noted that diagnostics revealed a posterior avulsion type injury consistent with pcl rupture; and advised claimant to wear his knee sleeve brace at all times when wal