physician performed a physical exam, took x-rays, prescribed medications, provided Ms. Myers with a knee brace, issued work restrictions and ordered an MRI.
The MRI was performed approximately two weeks later on January 8, 2016. The MRI indicated "marked degenerative joint change", a "full thickness meniscus tear" and an "abnormal appearance of the anterior cruciate ligament . . . A high-grade tear suspected." (Exhibit C, page 27).
Ms. Myers was then referred by the Employer/Insurer to Robert Paul, a board-certified orthopedic surgeon, on January 22, 2016. Dr. Paul's records were admitted both as medical records via a medical affidavit and also admitted as a medical report pursuant to R.S.Mo. §287.210.7. Accordingly, any opinions of Dr. Paul are admitted and properly considered by this Court.
Dr. Paul wrote Ms. Myers was injured while ". . . moving to a different building and crawling under her desk to unplug things and she had an audible pop with swelling and popping and clicking after that . . ." (Exhibit B, page 14). Dr. Paul performed a physical examination, reviewed the appropriate records including the MRI and made the following statement as to causation and treatment:
"This ACL injury is likely acute on physical exam and MRI. This ACL tear will likely exacerbate her symptoms of tricompartmental DJD and it may decrease the effectiveness of any conservative management. Our recommendation (sic) be a total knee arthroplasty, as anything else would not be appropriate and it would not help her symptoms, including an ACL type surgery. This is not appropriate in the setting of DJD." (Emphasis added). (Exhibit B, page 15).
Although the use of the term "acute" may not prove that the acute injury was the December 18, 2015 work event, it does preclude degenerative joint disease, a chronic condition, as the cause of Ms. Myers' injuries.
After this visit with Dr. Paul, no additional authorized treatment was provided by the Employer/Insurance Carrier. A mediation was held June 13, 2016, but the parties could not reach an agreement regarding the continuation of authorized medical treatment. Accordingly, Ms. Myers obtained a medical report to address the issue of causation, prevailing factor and appropriate medical treatment.
Ms. Myers was then seen by Dr. William O. Hopkins, board-certified orthopedic surgeon, on behalf of claimant. Based on review of Ms. Myers medical records and his physical examination, Dr. Hopkins stated as to causation:
"I believe with reasonable medical certainty that Ms. Myers sustained an injury to her right knee as a direct and prevailing factor of her work-incurred injury on or about December 18, 2015, when she was helping in a move and was under her desk in an awkward position unplugging computer equipment and felt pain in her right knee." (Emphasis added). (Exhibit A pages 5-6).
Dr. Hopkins states that he does not believe the medial meniscus tear could have been preexisting given Ms. Myers' degree of functioning prior to the work-related accident:
"Of major importance also was that there was a complex tear of the medial meniscus directly under the weight bearing area of the medial femoral condyle making contact with the medial tibial plateau. This type of meniscus tear would certainly be symptomatic and I do not believe that Ms. Myers could have performed work activities on a day-to-day basis with this type of tear, which would be painful with constant weight-bearing on a day-to-day basis." (Emphasis added). (Exhibit A, page 6).
Acknowledging the degenerative changes in the knee, Dr. Hopkins agrees with the opinion of the authorized orthopedic surgeon, Dr. Paul, that the only way to repair the work injury is with a total knee replacement:
"With these additional considerations, I would agree with her orthopedist Dr. Paul that performing an arthroscopic meniscectomy in the presence of even non-symptomatic degenerative changes in her knee is not associated with a satisfactory result and I would agree with his decision to perform a right knee replacement as treatment for her work-incurred injury on or about De