New ligament discovered in knee, Belgian surgeons say

Today's post is shared from the bbc.com

The anterolateral ligament (ALL) may hold the key to common knee injuries, researchers say Two knee surgeons in Belgium say they have identified a previously unfamiliar ligament in the human knee. Writing in the Journal of Anatomy, they suggest the fibrous band could play a part in one of the most common sports injuries worldwide. Anatomical sketch of ligaments  of the knee By Smitha MundasadHealth  reporter, BBC News Despite glimpses of the ligament in medical history, this is the first time its structure and purpose have been so clearly established, they say. But experts say more studies are needed to prove its relevance to knee surgery. Four main ligaments - or thick fibrous bands - surround the knee joint, criss-crossing between the upper and lower leg bones to provide stability and prevent excessive movement of our limbs. But the anatomy of the knee remains complex, and several international groups have been exploring the less-defined structures of the joint for some time. The notion of this particular ligament was first made by French surgeon Paul Segond in 1879 but it has evaded definitive surgical classification for many years. 'Extensive search' Now building on the work of other surgeons, Dr Claes and Professor Johan Bellemans of the University Hospitals of Leuven, Belgium, say they have closely mapped the band which runs from the outer side of the thigh bone to the shin bone. And they say this anterolateral ligament could play an...

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The Painful Knee: A Genetic Issue

Recent reports indicate that the pace at which aging knees deteriorate maybe a function genetics and that conservative treatment might indeed be the best approach.

"But in the end, genetics, and the kind of cartilage you got from your parents, may play the biggest role. It is a little like buying tires, said Dr. Frederick M. Azar, chief of staff of the Campbell Clinic in Memphis and an official with the American Academy of Orthopaedic Surgeons. “You can get nice treads or you can get retreads,” he said."

Read the complete report: Why Do My Knees Hurt? (NYTimes 3.15.13)

Medical Witness Cannot Be An Advocate - Knee Replacement Surgery Authorized

A workers' compensation medical witness is not permitted to be become an advocate. A Judge of Compensation disregarded an insurance company medical witness when the medical expert "crossed the line from being a medical witness to an advocate."

In reaching her decision, Diana Ferriero, Judge of Compensation, rationalized that the insurance company's medical expert by the "convoluted cover letter sent by respondent counsel," along with medical records on the injured worker. 

The injured employer suffered two work related accidents as a mechanic for American Airlines. The first accident in to the right knee occurred in July 2004 and resulted in a partial menisectomy and no prolonged sequelae. The worker was symptom free until a second accident in January 2007when he slipped and fell on both knees and hands. The insurance company authorized 28 medical office visits, 15 Hyalgan injections, 14 aspirations and physical therapy for treatment to his right knee. A diagnosis was made by the treating physician and the insurance company refused the injured worker a total knee replacement claiming that the medical condition was unrelated to the 2nd accident of January 2007.

The workers' compensation Judge ordered an independent medical evaluation by a renowned specialist in knee and hip replacements, Mark A, Hartzband of the Hackensack University Medical Center. The judge concluded that, "Dr, Hartzband opined that petitioner's need for a right total knee replacement was directly and causally related to the accident of January 17, 2007."

The court also found that the insurance company's treating physician, who opined that the 2nd accident was unrelated to the need for a knee replacement, was "disingenuous given the contents of his office chart," and reasoned that the insurance company's authorized treating physician did not have an understanding of arthritis and its progression.

The court granted the injured workers' motion for medical treatment, evaluation and scheduling of the right knee replacement, and ordered the payment of temporary medical benefits.

Pepe v. American Airlines, CP No. 2008-5878, NJ DWC 2010), Decided November 11, 2010.

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Knee Replacements: An Over Sold Procedure

The following post is shared from Kaiser Health News authored by Liz Szabo:

"Research suggests that up to one-third of those who have knees replaced continue to experience chronic pain, while 1 in 5 are dissatisfied with the results. A study published last year in the BMJ found that knee replacement had “minimal effects on quality of life,” especially for patients with less severe arthritis.

Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear

Today's post was shared by NEJM and comes from www.nejm.org

Background Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking. Methods We conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. The primary outcomes were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (each ranging from 0 to 100, with lower scores indicating more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10, with 0 denoting no pain) at 12 months after the procedure. Results In the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. The mean changes (improvements) in the primary outcome measures were as follows: Lysholm score, 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group (between-group difference, −1.6 points; 95% confidence interval [CI], −7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively (between-group difference, −2.5 points; 95% CI, −9.2 to 4.1); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference, −0.1; 95% CI, −0.9 to 0.7). There were no...

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You may not be better off after knee surgery

Today's post is shared from cnn.com 

(CNN) -- Patients who underwent simulated knee surgery fared just as well as those who got the real deal, according to a new study that's raising eyebrows about the most common orthopedic procedure performed in the United States.

The findings, published Thursday in the New England Journal of Medicine, add to a string of papers suggesting that arthroscopic partial meniscectomy fails to help many patients. The operation typically is performed to relieve knee pain, whether from wear or from an injury.

But other doctors say it's still too soon to draw sweeping conclusions.

The study, which was conducted in Finland, followed 146 patients between the ages of 35 and 65 with symptoms of degenerative wear and tear of the meniscus, a disk-shaped piece of cartilage that acts as a shock absorber between the shinbone and thighbone. They had no detectable arthritis, suggesting that any pain was due to a problem with the meniscus.

About half the patients underwent an arthroscopic meniscectomy, in which a surgeon inserts a blade through a tiny incision in the knee, and essentially shaves down the rough, frayed edges of the meniscus.

The other half underwent an elaborately staged "sham" surgery, in which the doctor made an incision and poked around without any actual manipulation, shaving or cutting.

A year later, there was no significant difference in the knee pain reported by patients in each group. Nearly two-thirds on each side said they were happy with the results, and most said...


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Aggravation of Prior Knee Injury Compensable in Workers Compensation

A worker who suffered an injury to a knee with a pre-existing arthritic condition was awarded workers' compensation benefits. A Wyoming court of appeals reversed a trial level decision and found that evidence existed to sufficiently establish that a fall in the workplace resulted in a material degree to have aggravated the preexisting condition.

"The claimant has a previous history of significant obesity. At 5′2″ tall with weighing close to 250 pounds, she has had extensive and excessive weight bearing on her knees. The left knee has already been replaced secondary to severe end-stage degenerative arthritis. "

The Court held, "The evidence is undisputed that despite Judd's preexisting degenerative condition, she was able to work fulltime without restriction before her work injury, and after her work injury, she suffered debilitating pain that prevented her from putting weight on her knee and from working. The work injury brought Judd's need for surgery to a head, and the Medical Commission erred in denying benefits for the surgery. The case is reversed and remanded for the award of appropriate benefits."

Judd v. State ex. rel. Wyoming Workers' Safety and Compensation Div., ___P.3d____, 2010 WL 2541673 (Wyo. 2010) Decided June 25, 2010

To read more about knee injuries and workers' compensation click here.

Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits. You may e-mail Jon  Gelman or call 1-973-696-7900. 

Medical Treatment is an Exclusive Remedy Not a Reasonable Accommodation

The NJ Supreme Court has held that the provision of medical treatment does not equate to a "reasonable accommodation", therefore an employee cannot claim under the Law Against Discrimination [LAD] that failure to provide medical care was actionable. The provision of medical treatment is an exclusive remedy of the Workers’ Compensation Act.

Knee Replacement Medical Device Recalled

The US Food and Drug Administration  (FDA) has notified healthcare professionals of a Class I recall of the LPS Diaphyseal Sleeve, a manufactured medical device used in human knee replacement surgery.

It has been found that The LPS Diaphyseal Sleeve to Diaphyseal Sleeve Base taper connection may not be sufficient to accommodate potential physiologic loads that may be transferred to the junction during normal gait activities by some patients. This may result in fracture of the sleeve at the taper joint which may also lead to loss of function or loss of limb, infection, compromised soft tissue or death.

The device was manufactured by: DePuy Orthopaedic, Inc, a company owned by Johnson and Johnson.

Insufficient Evidence: When "A Lot" is Not Enough

A Judge of Compensation's opinion must be supported by objective medical evidence and not merely based upon an inadmissible net opinion of a medical expert.

NJ Judge Orders Psychotherapy Sessions In Conjunction With Pain Management

A NJ Workers' Compensation Judge Ordered the continuation of medical services to an injured worker who has been struggling for years because of chronic knee pain depression and anxiety despite the objection of the employer who sought to terminate care. The Judge Philip A. Tornetta, Administrative Supervisory  Judge of Compensation, adopted an innovative approach  in attempt to reduce or eliminated prescribed drugs including, "Oxycontin for her knee  pain, Lexapro for depression and Xanax, which helps her sleep."

Common Knee Surgery Does Very Little for Some, Study Suggests

A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports.

The unusual study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilize knees. Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the United States, performed, the study said, about 700,000 times a year at an estimated cost of $4 billion.

The study, conducted in Finland, involved a small subset of meniscal tears. But experts, including some orthopedic surgeons, said the study added to other recent research suggesting that meniscal surgery should be aimed at a narrower group of patients; that for many, options like physical therapy may be as good.

The surgery, arthroscopic partial meniscectomy, involves small incisions. They are to accommodate the arthroscope, which allows doctors to see inside, and for tools to trim torn meniscus and to smooth ragged edges of what remains.

The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries. But about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.

“Those who do research have...
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Workers Compensation Insurance Company Ordered to Pay For Gastric Bypass

Treating medical conditions that are necessary to relieve and cure a medical condition is the responsibility generally of workers' compensation programs throughout the United States. Now a Court has ordered that an insurance company must treat a persons obesity as an extension of its medical benefits so that weight reduction can occur and the underlying work related condition can be addressed.

"Claimant slipped and fell at work in 2002, and his ensuing workers' compensation claim presently encompasses, among other things, injuries to his head, neck, back and knees. His morbid obesity has contributed to his knee and back problems and, in an effort to combat those problems and counter a broader threat to his survival, claimant sought authorization to undergo gastric bypass surgery. The Workers' Compensation Law Judge granted his request. Upon review, the Workers' Compensation Board affirmed, holding that the surgery was causally related to the compensable injuries. 

In affirming the decision the Supreme Court, Appellate Division, Third Department, New York held:

"The employer is obliged to pay for claimant's medical care “for such period as the nature of the injury or the process of recovery may require” (Workers' Compensation Law § 13[a]; see Matter of Spyhalsky v. Cross Constr., 294 A.D.2d 23, 25-26 [2002] ). There is evidence in the record that claimant has gained a substantial amount of weight since 2002 due to the sedentary lifestyle imposed by the compensable injuries. Claimant's treating orthopedic surgeon opined that claimant's back and knee pain was exacerbated by his obesity and that such could be alleviated by weight loss. An independent medical examiner agreed, opining that weight loss would “certainly” help those conditions. While material in the record before us could support a different result, substantial evidence exists for the Board's determination that claimant's weight gain was caused by his compensable injuries and that gastric bypass surgery “would assist in [his] recovery” ( Matter of Bolds v. Precision Health, Inc., 16 A.D.3d 1007, 1009 [2005]; see Workers' Compensation Law § 13[a]; Matter of Spyhalsky v. Cross Constr., 294 A.D.2d at 25-26, 743 N.Y.S.2d 212).

Laezzo v. New York State Thruway Authority, --- N.Y.S.2d ----, 2010 WL 812862, N.Y.A.D. 3 Dept., 2010, March 11, 2010.

Click here to read more about obesity and workers' compensation.

Blue Cross North Carolina’s Price Tool Could Shake Up Medical Industry

Today's post was shared by Kaiser Health News and comes from kaiserhealthnews.org

Leslie Goldfarb of Charlotte had been talking to two surgeons about knee surgery and worrying about her out-of-pocket costs.

When she recently read about a new online database from Blue Cross and Blue Shield of North Carolina, she checked the average reimbursement for those surgeons. One of them averaged about $1,500 less in total costs associated with the arthroscopic surgery she’s having. And Blue Cross pays about twice as much if the same doctors do the procedure in a hospital – costs that pass through to her with a high-deductible plan.

She used that data to schedule her surgery.

“You don’t have to legislate medical costs to come down,” Goldfarb said. “All you have to do is make the information available.”

That’s the idea.

Until recently the cost of medical care had been a closely guarded trade secret and patients had little reason to care when health insurance covered most of the expense. Now, however, as patients become responsible for more of their medical costs, such information is seeping out through online tools.

How that will play out in the medical marketplace remains to be seen, but Blue Cross’ North Carolina disclosure is creating national buzz. A recent post on Forbes.com said it could “represent the dawn of a new age in health care.”

“Transparency in general is a good thing,”...

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Does Knowing Medical Prices Save Money? CalPERS Experiment Says Yes

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

The fact that the cost of a hip replacement can ring up as $15,000 or $100,000 — depending on the hospital — makes a lot of people uncomfortable. But that’s only if they know about the wide price tag variations. In an effort to raise awareness and rein in what can seem like the Wild West of health care, the California Public Employees’ Retirement System (CalPERS), the second largest benefits program in the country, and Anthem Blue Cross started a “reference pricing” initiative in 2011. The initiative involved a system to guide their enrollees to choose facilities where routine hip and knee replacement procedures cost less than $30,000. Here’s how it works: The CalPERS program designated certain hospitals that met this cost threshold, and enrollees who chose among these facilities pay only the plan’s typical deductible and coinsurance up to the out-of-pocket maximum. Patients who opted for other in-network hospitals were responsible for regular cost sharing and “all allowed amounts exceeding the $30,000 threshold, which are not subject to an out-of-pocket maximum,” noted the report. The results tallied savings of $2.8 million for CalPERS, and $300,000 in patients’ cost sharing, according to research released Thursday by the Center for Studying Health System Change for the non-profit group National Institute for Health Care Reform. Researchers found that patients who received “intensive...

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Standing Desks at Work Deemed Not Beneficial

Before employers buy standing workstations and/or even treadmills to prevent repetitive motion claims, they ought to take heed of a recent study that considers them a useless fad. The newest marketing craze is work at standing desks, some even equipped with treadmills and marked as ergonomically safer for an employee’s health.

Defense Firm Prohibited From Seeking Unfettered Medical Discovery

A defense firm, that had a “custom” of seeking unlimited medical discovery in workers’ compensation claims, was barred from utilizing that litigation tactic. The NJ Appellate Division affirmed the trial level decision of The Honorable Emille R. Cox, Supervising Judge of Compensation that prohibited requests for unlimited medical data.

Illinois Punishes Workers for Employer Deceit

The efforts by employers, insurance carriers and the Chamber of Commerce in Illinois, to take away the rights of injured workers and strip them of benefits may have all been based on Industry fraud. Recently obtained documents, secured under the Illinois Freedom of Information Act (FOIA), reveal that the employer’s own doctor had in-fact validated the causal relationship of the medical claims of the injured workers to work. 

A campaign in Illinois by Industry to dismantle the State’s workers’ compensation system was triggered and flamed by a story appearing in a local newspaper asserting that several correction officers had filed fraudulent claims for repetitive motion trauma to their hands. The local news report insinuated that the claims could not have been credible. 

The story, for some suspicious reason, was disseminated in a viral manner on the Internet. Concurrently, the Illinois Chamber of Commerce went on the attack claiming that the workers’ compensation system in Illinois was loaded with fraudulent activities. The Chamber and employers lobbied for legislation to strip injured workers of what little rights they still had under the law. The statutory changes they sponsored reduced ill workers access for benefits, reduced medical treatment expenditures by 30%, and set up a series of hurtles that left the injured without remedy to cure and relieve conditions caused by work. 

Even that wasn’t enough. Supporters of the Industry’s draconian legislative effort, have now vowed to return to take away the basic promises granted workers a century ago, that injured workers could obtain the limited and capped scheduled benefits, under a no-fault system. The workers’ compensation system was intended to provide a remedial and expeditious benefit to injured workers in a summary and efficient fashion, without the element of fault being considered. 

A hidden report reveals that Anthony E. Sudekum, MD, a Board Certified Hand Surgeon, retained by the employer, State of Illinois Department of Corrections, on March 30, 2011, after and extensive review of the facts, circumstances, inspection of the premises and equipment, and examination of the employees, concluded that, on the job activities contributed to their illness. He wrote, “…I feel that ….work activities at Menard Correctional center served to aggravate…bilateral carpal tunnel syndrome and left ulnar neuropathy.” 

Furthermore, some contend that the neurological illnesses that appeared at the Menard Correctional Center may have been the result of a mysterious disease cluster that warrants much further investigation instead of a knee-jerk denial. Similarly, a mysterious outbreak of disease in Philadelphia ultimately resulted in the discovery of Legionnaires Disease. Today the US Centers for Disease Control continues to investigate worldwide clusters of gastro-intestinal conditions to determine their potential causal relationship. It is through continued medical research and investigation that we make the workplace healthier, safer and more productive. 

We should learn from history. In the past, employers and manufacturers were also caught intentionally concealing the hazards of asbestos, tobacco and lead paint. That left a legacy of disease and death, and billions of dollars of economic loss. One would think that everyone learned from those tragic mistakes. For our nation to survive, employers must take an active roll in improving the health of our workers, and build a stronger system, rather than just deny the hazards of the workplace and blame the injured.

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Employer Fraud: Safety Manager Conceals Employee Injuries for Bonus

On Apr. 11, 2013, Walter Cardin, 55, of Metairie, La., was sentenced to serve 78 months in prison followed by two years of supervised release, by the Honorable Curtis L. Collier, U.S. District Judge. Cardin was convicted at trial in November 2012, after being charged by a federal grand jury with eight counts of major fraud against the Tennessee Valley Authority (TVA), an agency of the United States.

The indictment and subsequent conviction of Cardin was the result of a six-year

investigation conducted by the TVA-Office of Inspector General (TVA-OIG). The trial revealed that Cardin, as safety manager for the Shaw Group (formerly Stone & Webster Construction) at TVA’s Brown’s Ferry Nuclear site in Athens, Ala., provided false and misleading information about injuries at that facility as well as TVA’s Sequoyah Nuclear site in Soddy Daisy, Tenn., and TVA’s Watts Bar Nuclear site near Spring City, Tenn. 

The Shaw Group had a contract with TVA to provide maintenance and modifications to the three facilities and to provide construction for the Brown’s Ferry Unit Number 1 reactor restart. Cardin generated false injury rates which were used by the Shaw Group to collect safety bonuses of over $2.5 million from TVA. As part of a civil agreement filed with the United States in 2008, the Shaw Group paid back twice the amount of the ill-gotten safety bonuses.

California: Medical Delay and Denial Protested

Sedgwick vs. The People

Round 4: Sedgwick v. Debbye Mazzucca

Operating Room Nurse’s Injury no Emergency to Kaiser, Insurer: Defy Judge’s Order, Refuse to Provide Urgent Medical Care Injured Workers’ Advocates to Seek Penalties, Investigation

The California Applicants’ Attorneys Association (CAAA), whose members represent Californians injured on the job, today held a news conference outside Kaiser Foundation Hospital with Debbye Mazzucca, a former operating room nurse who was injured while working there. They called for sanctions against Sedgwick Claims Services, Kaiser’s workers’ compensation insurer, for defying a judge’s order to provide Ms. Mazzucca urgently needed medical care, causing her to lose her teeth. On February 11, 2013, the Workers’ Compensation Appeals Board (WCAB) ordered that Sedgwick “shall” provide dental treatment to Ms. Mazzucca. After eight months, Sedgwick and Kaiser have still refused to do so. Sedgwick faces a relatively small monetary penalty for ignoring the court order, which means little to a huge corporation.

Operating Room Nurse Debbye Mazzucca, of La Mesa, has thirty-five years’ experience, and worked for Kaiser for 12 years. She was injured in 1998, when she tripped and fell over a parking lot barrier while at work. Kaiser treated her injured knee, but ignored multiple doctors’ reports that she had also injured her neck and back. In spite of four doctors reports confirming that fact, Kaiser denied that those injuries were from the fall. Now, due to complications from medications, and delays in approving medical care, Ms. Mazzucca has lost her teeth.

CAAA President Jim Butler said, “Insurers’ Utilization Review (UR) routinely delays and denies doctors’ legitimate requests for appropriate medical treatment. This is unnecessary and expensive, and has got to change. We’ve seen the evidence of out-of-control delay and denial in the 15,000 denials of recommended medical care in just the month of August. It’s time to bring UR to heel, and stop insurance carriers from using it as a routine roadblock.”

“A doctor, agreed to by the company and their insurer, determined this Kaiser operating room nurse’s injury was a result of her work accidents. The insurer still refused to provide urgent medical care. A judge ordered the insurer to provide urgently needed medical care. But Sedgwick continues to refuse medical care and Debbye lost all her teeth during the months of delay,” said Alicia Hawthorne, the president of CAAA’s San Diego chapter, and Ms. Mazzucca’s attorney. “This nurse has been in pain, and in need of medical treatment. Yet, the insurance company defied a judge’s order to provide care. Kaiser and its insurer have spent years fighting their responsibility to treat these injuries. Why does the State of California allow workers’ compensation insurance companies to further damage patients through delaying and denying medical care and disability compensation?”

 “Kaiser has failed to provide the care needed to heal my injuries,” Mazzucca told a news conference outside Kaiser Foundation Hospital in San Diego. “For years, all they would approve were painkilling drugs. These drugs’ side effects have caused more medical problems, including ‘dry mouth syndrome,’ which is insidious and dangerous. The drugs prevent your saliva glands from working properly, causing your teeth and gums to deteriorate.  Mine became infected, abscessed and threatened my health and my life. In 2010, my teeth started cracking and breaking off at the roots. I lost seven of my teeth this way.”

Sedgwick denied the dental treatment I needed, so Ms. Mazzucca took them to court.  In February 2013, the judge ordered Sedgwick to provide this urgent medical treatment. To this day, they have refused to do so. “It has been more than a year and a half since the medical expert the insurer agreed upon said I urgently needed dental care. The pain and infection became so unbearable in July that my doctor sent me to the emergency room, and 25 of my teeth were removed. I then spent the entire month of July in the hospital, in agony, and on painkillers. Kaiser and their insurance company are defying a judge’s order to provide urgently needed medical care,” said Mazzucca.

Today’s release is the fourth in CAAA’s series of cases spotlighting the abuse of Utilization Review (UR) and other methods for delaying and denying legitimate medical care and disability compensation in the workers’ compensation claims handling practices of insurers like Sedgwick Claims Management Services.

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