The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

A file review was held on April 6, 2006, at the request of an advocate, acting on the worker's behalf.

Issue

Whether or not responsibility should be accepted for the osteoarthritic changes in the worker's right knee as being related to the compensable injury of May 15, 1985.

Decision

That responsibility should not be accepted for the osteoarthritic changes in the worker's right knee as being related to the compensable injury of May 15, 1985.

Decision: Unanimous

Background

Reasons

Claim History
On May 15, 1985, the worker sustained a compensable compound fracture to his right tibia and fibula. In about 1989, the worker was told that he had osteoarthritis in his right knee. The Workers Compensation Board (hereafter the "WCB") took the position that the osteoarthritis was not related to the worker's compensable injury, but rather a prior non compensable injury in 1980 for which the worker underwent a meniscectomy in 1981. This position was maintained by the Review Office in an October 18, 1996 decision. It is this decision that the worker appeals.

Background
On May 15, 1985, the worker was putting steel catwalk plates upright when they flipped back and fell on his leg, crushing the bottom part of his right leg in two places. He underwent surgery to repair the break and a below the knee cast was applied.

In August, 1985, the orthopaedic surgeon who treated the worker, noted that the worker had complained about some aching in the knee shortly after the cast was applied which he attributed to a walking heel on the worker's cast. Right knee pain was also noted by the worker's family physician on April 7, 1986 and then again on May 2, 1986 by the orthopaedic surgeon. The orthopaedic surgeon thought that the pain and weakness was due to weakness of the quadriceps muscles. He found no evidence to suggest significant ligament laxity or a medial meniscus lesion.

Then an x-ray on October 18, 1988 revealed some evidence of degenerative change in the lateral compartment. A further x-ray of the right knee on October 24, 1989 revealed osteoarthritis. The orthopaedic surgeon thought that the osteoarthritis was due to the worker's 1980 right knee injury for which he had performed a lateral meniscectomy.

The worker's family physician disagreed with this position. On June 3, 1991, he wrote:

"It has been my contention that [the worker's] present condition of osteoarthritis of the right knee occurred subsequent to his accident of 1985 and was traumatically induced by this accident.
I base this contention on the fact that in his Operative Report of February 4, 1981 for right lateral meniscectomy, [the orthopaedic surgeon] stated that, at that time, "There was no other abnormality detected in the knee joint." Also, careful perusal of [the worker's] file in this office indicates no reference to any problem with this knee from August 1981 until May 1985 (the date of the second injury) in spite of the fact that [the worker] was seen frequently regarding other medical problems."

In a December 9, 1991 report, the orthopaedic surgeon reiterated his opinion that the worker's osteoarthritic knee condition was not the result of his workplace injury but rather the 1981 lateral meniscectomy that was performed as a result of a torn right lateral meniscus.

The worker continued to complain of right knee pain. An x-ray on May 22, 1992 revealed marginal spurring along the lateral compartment as well as some minor degenerative changes at the patellofemoral joint.

Then in 1998 the worker saw a second orthopaedic specialist for his right knee. In June, 2005 the second orthopaedic specialist was questioned about the relationship of the worker's osteoarthritis to his compensable injury by a third party. The third party advised the second orthopaedic specialist that the worker was struck by a 1200 pound steel sheet proximal to his knee joint, which caused fractures distal to the knee joint. The question put to the second orthopaedic specialist was whether in his opinion and on a balance of probabilities the worker's osteoarthritic changes and symptoms of the right knee were directly or indirectly caused, wholly or in part, by the workplace injury of 1985.

The second orthopaedic specialist found that given substantial valgus force was applied to the worker's lateral knee at the time of the workplace accident, there would have been compressive force to the lateral compartment of the knee. This compressive force together with the fact that the tibia healed with mild extended rotation deformity could have had an adverse effect on the lateral joint. While osteoarthritis very often follows a meniscectomy, he found that the onset was more rapid than usual in the worker's case. He therefore found that the workplace accident substantially contributed to the worker's osteoarthritis to a level of 25%.

Analysis
The issue before the panel is whether responsibility should be accepted for the osteoarthritic changes in the worker's right knee. To accept this appeal we must determine that the workplace accident played a role in the worker's condition. We are unable to make this determination.

The worker underwent a meniscectomy to his lateral meniscus for a non-compensable medical problem in 1981. This is the same area in which the osteoarthritis developed seven years later. As stated by both the treating orthopaedic surgeon and second orthopaedic specialist, osteoarthritis is a known complication of a meniscectomy.

On a review of the evidence, the workplace accident does not appear to have involved the lateral compartment of the right knee. The workplace accident in 1985 is described as an injury to the lower right leg as a result of a steel sheet falling on the worker. The operative report of May 15, 1985 indicates that the fracture occurred at the mid and lower third of the tibia and the upper third of the fibula. There is no indication of any examination or tests involving the worker's right knee or upper leg. There is however, notation of right ankle pain and swelling.

We accept the treating orthopaedic surgeon's opinion that the osteoarthritis was caused by the earlier non-compensable injury. He treated the worker in 1980 and 1981 as well as after the 1985 workplace accident.

For these reasons, the worker's appeal is denied.

Panel Members

L. Martin, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

L. Martin - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 17th day of May, 2006