The Appeal CommissionThe Workers Compensation Act of Manitoba

Background

The worker suffers from a pre-existing bilateral knee condition called patellofemoral syndrome. This condition is aggravated by bending at the knees. The worker aggravated this pre-existing condition in December 2002 when she strained her right knee, and again in September 2003 while going up the stairs at work.

Though the worker experienced more pain in her right knee (than left) before the September 2003 incident, medical reports after this date note pain complaints in both knees. Physiotherapy and reduction in the use of her knees improved her symptoms. However, by the fall of 2004, she began to have increased knee pain, more on the right than the left. Bilateral knee braces were prescribed.

Then on December 21, 2004 the worker was carrying a table with a co-worker when she felt a “crunch” along the outside of her left knee. This incident was reported by the employer to the WCB on January 12, 2005 which accepted it as a recurrence of her September 2003 compensable incident and paid her a full day of wage loss.

The worker says that this December 2004 incident caused her increased left knee pain. Physiotherapy reports in January 2005 record this increased left knee pain as does a March 2005 report from her treating orthopaedic surgeon. The orthopaedic surgeon confirmed the diagnosis of patellofemoral syndrome but also felt that the worker might have torn her left lateral meniscus. This was ruled out on a March 22, 2005 MRI.

However, given the worker’s continuing complaints and prior x-rays revealing subluxation of the patella, the orthopaedic surgeon recommended a lateral release of the left knee. This was done on July 8, 2005. The post-operative report indicates that the left patella was laterally subluxed at approximately 50%.

As stated previously, this surgery was not accepted by the WCB, as it was determined that it was required because of the worker’s pre-existing condition.

This was the worker’s treating orthopaedic surgeon’s opinion which is expressed in a June 13, 2005 chart note:

“[The worker]…has some concerns in regards to the etiology behind her symptoms and is very concerned that the WCB is not compensating her or paying for her procedure. I discussed with [her] the etiology and although I do certainly sympathize and agree that it can be exacerbated by her occupation, I can by no means say definitively that it was caused by her occupation…”

He confirmed this opinion in a March 3, 2006 letter to the worker’s worker advisor:

“…while I agree that her employment may exacerbate her symptoms…given my physical examination…her patellar tracking was an underlying factor exacerbated by her employment. Certainly, I could not establish a cause and effect relationship in this regard…I believe that she is predisposed to patellofemoral syndrome as a result of her tight lateral retinaculum and increased Q angles. As I have stated previously, however, any employment resulting in frequent bending, lifting, squatting, etc. would certainly exacerbate the symptoms of any patient who has patellofemoral syndrome.”

The orthopaedic consultant to Review Office also agreed that the surgery was solely related to the worker’s pre-existing knee condition.

Worker’s Position

The worker says that responsibility should be accepted for the July 2006 surgery. She says that before the December 2004 incident, she had mainly right knee complaints and surgery was not an option. This changed after December 2004; her left knee became more symptomatic and surgery was required.

Employer’s Position

The employer says that the worker’s left knee surgery was not related to her compensable injury. It says that this was the normal consequence of her pre-existing condition.

Analysis

To accept the worker’s appeal we must find on a balance of probabilities that the left knee surgery was causally related to the worker’s compensable injury. We are unable to make that finding.