At the time of her accident, the employee, Lawana Fay Rowland, was employed as a childcare worker by Farmington Children's Home. The employee's accident occurred when she was kicked by a female resident in the lock down unit. The medical records indicate the employee was kicked in the back of her leg slightly above her left knee.
Both the employee's testimony and the medical records confirm the employee had a significant history for bilateral knee complaints and treatment. Dr. John Wagner performed a lateral release on both of the employee's knees sometime in the mid 1980's. On December 18, 2001 the employee saw Dr. Wagner with complaints of pain and swelling in her left knee. The employee advised Dr. Wagner that she had tripped over a piece of carpet at work. She told Dr. Wagner that after a few weeks, she discussed her injury with her employer, and they indicated since there was no sign of trauma, they would not accept it as a workers' compensation case. The employee did not file any claim for the 2001 incident (Employer's Exhibit 1.
Dr. Wagner's records from December 18, 2001, indicate the employee was experiencing swelling in her left knee every evening, and this had been going on for a long time. The employee also told Dr. Wagner that she had previously been advised that she had evidence of osteoarthritis. An MRI taken on November 7, 2001 showed scelerosis of the medial tibial plateau. Dr. Wagner concluded that the employee had chondromalaciathat "may have been triggered a bit by her incident at work, and then will resolve". Dr. Wagner prescribed Naprosyn, and scheduled the employee for a two-month follow up (Employer's Exhibit 1).
Prior to her return visit with Dr. Wagner, the employee had her accident on February 5, 2002, that is the subject of this claim. Following the kicking incident, the employee emphasized that this time, she reported her accident.
The employer initially authorized treatment with Nurse Practitioner Susan Nesbit and Dr. Edward Dumontier at the Parkland Health Clinic in Farmington. The medical records from Parkland Health Clinic dated February 8, 2002 indicated that the employee gave a history of being kicked in the knee, and complained of "continued edema and pain of knee" (Employer's Exhibit 4).
The employee told Nurse Nesbit about her October accident in which she had tripped on the carpet, but stated that "overall she was starting to do better until the recent episode" (Employer's Exhibit 4). The employee also reported that she had tried someone else's Vioxx, and it worked better than Naprosyn. The employee was diagnosed as having a left knee contusion and treated with a knee immobilizer and a prescription for Vioxx. The employee was allowed to return to work, but was advised not to work in the lock down unit. (Employer's Exhibit 4).
In a follow up visit on February 15, 2002, the employee stated she was feeling better. Nurse Nesbit encouraged the employee to attend her physical therapy sessions, and recommended that she continue to use the immobilizer and Vioxx (Employer's Exhibit 4).
Records from Farmington Sports and Rehabilitation Center indicate the employee had physical therapy for her left knee on February 18, 2002, February 28, 2002 and March 7, 2002. The employee was then referred to Dr. William Harris, who is an orthopedic surgeon in Farmington Missouri. Dr. Harris treated the employee conservatively for several months prior to recommending surgery. During this time the employee continued to complain of pain and swelling in her left knee. Dr. Harris diagnosed the employee has having chondromalicia and synovitis of the left knee (Employer's Exhibit 6and 7).
The operative report dated August 26, 2002 indicates a post-operative diagnosis of grade IV chondromalicia changes of the femoral groove and medial tibial plateau with grade III chondromalicia changes of the under surface of the a patella with anterior patellofemoral synovitis with interarticular loose body (Employer's Exhibit 7). Dr. Harris' medical record of August 27, 2002 notes the employee had grade IV osteoarthritic changes and erosion down to the bone of the tibial plateau. Although the employee had synovitis, she did not have a meniscus tear (Employer's Exhibit 6).
After her surgery, the employee continued to see Dr. Harris on a periodic basis until April 8, 2003. During this time period, the employee continued to complain of pain and swelling in her left knee. Dr. Harris recommended a series of synvisc injections, but the employee showed only limited improvement (Employer's Exhibit 6).
On April 10, 2003, the employee was examined by Dr. Richard Rende, who is an orthopedic surgeon in St. Louis Missouri. Based on his examination and the x-rays taken of the employee's left knee, Dr. Rende concluded that the employee was suffering from "advanced degenerative arthritis with bone against bone in the medial joint space and significant narrowing of the patellofemoral joint space (Employer's Exhibit 8). Dr. Rende felt that the employee's degenerative arthritis was "of long standing duration". Although Dr. Rende agreed that the employee needed a knee replacement, he did not feel her need for a knee replacement was "in any way work related" (Employer's Exhibit 8). He added "it is my opinion that any aggravation of it by this kick clearly has come and gone, and I believe she is at her maximum medical improvement" (Employer's Exhibit 8). Dr. Rende gave the employee several permanent restrictions, but did not believe her restrictions "were the result of an on the job injury" (Employer's Exhibit 8).
During Dr. Rende's deposition testimony, he restated his conclusion that the employee's current complaints were caused by her osteoarthritis (Employer's Exhibit 9, page 6) and confirmed that he did not believe that her February 5, 2002 work incident was a substantial factor in causing the employee's need for a total knee replacement (Employer's Exhibit 9, page 7). Dr. Rende also noted that during the arthroscopic surgery there were no s