Diagnostic Assessment — Left Knee - Dislocation History
Example 1 of 1 · fictitious patient (Veteran O)
Diagnostic Assessment
Left Knee - Dislocation History
Balance of Probabilities SOP: Dislocation of a Joint and Subluxation of a Joint No. 56 of 2019 Reasonable Hypothesis SOP: Dislocation of a Joint and Subluxation of a Joint No. 55 of 2019
ADF History
The veteran, Rifleman, 11/06/2013, [date withheld]
Occupational History
Infantry training at the School of Infantry involves high-impact activities including running, jumping, tactical movement exercises, combat training, obstacle courses, and field exercises that place significant stress on joint structures and predispose to dislocation injuries through sudden directional changes and high-impact landings.
History
The veteran the veteran a Rifleman with the Australian Army, sustained a traumatic left knee dislocation during infantry training at the School of Infantry, the base, approximately in 2013-2014 when he was 19-20 years old, resulting in hospitalization and ongoing chronic symptoms.
Timeline
- circa 2013-2014 - Initial traumatic left knee injury during infantry training at School of Infantry, the base. The mechanism involved knee giving way, collapsing, and then woke up in the clinic suggesting severe dislocation with possible loss of consciousness from the trauma. The injury was severe enough to require hospitalization for several days followed by extensive rehabilitation over months. This represents the index injury that established his ongoing left knee condition during mandatory military training activities as part of his initial infantry qualification.
- circa 2015 - Secondary traumatic episode occurred approximately 18 months after the initial injury when he slipped on ice and re-injured the same knee during military service. This second injury occurred during winter conditions and represented re-trauma to an already compromised joint structure, further damaging healing tissues and contributing to ongoing instability and chronic pain symptoms.
- 2016-2017 - During an overseas area of operations deployment on Operation HIGHROAD, his left knee condition was aggravated by operational activities including repetitive vehicle operations. Post-deployment medical examination documented that the condition became a niggling issue towards the middle and end of the deployment and may have been aggravated by recurrently getting out of vehicle leading with his left leg. The repetitive nature of vehicle operations during deployment placed additional stress on the compromised joint preventing proper rest and recovery.
- 18 August 2011 - First formal medical presentation for ongoing left knee pain at the treating doctor Health Centre. The veteran reported Developed Knee pain while n the base, further more after deployed to an overseas area of operations - has slipped couple of times and developed pain while deployed. Clinical examination revealed he finds hard to put weight on the knee when kneeling, not difficult to walk or run, not giving away with physical examination showing Tender on the tibial tuberosity and the infrapatellar tendon.
- 29 August 2011 - Comprehensive medical assessment by the treating doctor documenting detailed history of knee giving way, collapsing, and then woke up in the clinic - thinks maybe dislocated but cant be certain. Secondary injury history documented as About 18 months ago slipped on ice, hit it with current symptoms including inability to kneel for more than 30 seconds due to excruciating pain but maintaining ability to walk and run.
Symptoms
At the time of initial injury, symptoms included knee giving way, collapse, and loss of consciousness suggesting severe trauma to joint structures. Following extensive rehabilitation, ongoing symptoms included instability, chronic pain with kneeling activities, and functional limitations. Current symptoms include chronic knee pain, inability to kneel for extended periods due to excruciating pain, pack marching difficulties, and recurrent hyperextension episodes affecting military duties and daily activities.
Imaging
20 August 2011: No fracture or dislocation is identified. No major bone or joint space abnormality is identified. No patellar fracture is seen. 20 August 2011 Ultrasound: There is a trace of suprapatellar joint and There is a trace of fluid deep to the patellar tendon
1. What is the formal diagnosis of the condition claimed above?
Left knee dislocation history (Z87.81), Dislocation of a Joint and Subluxation of a Joint SOP No. 56 of 2019, ICD-10 code Z87.81.
A dislocation of a joint means an episode of displacement of a joint such that there is complete loss of contact between the articulating surfaces of the bones. Knee dislocation is a serious orthopaedic emergency involving disruption of multiple ligamentous structures including cruciate and collateral ligaments, with potential for neurovascular compromise. The mechanism described with loss of consciousness indicates the severity of the initial trauma. Knee dislocations require immediate reduction and comprehensive rehabilitation. Even after appropriate treatment, patients often experience chronic instability, pain, functional limitations, and increased risk of post-traumatic arthritis. The temporal relationship between the initial trauma and ongoing symptoms establishes this as a significant service-related injury with long-term consequences.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? Circa 2013-2014 during infantry training at School of Infantry, the base, when he was approximately 19-20 years old. [CHART REVIEW.docx]
When did the veteran first present to a health/medical provider for this condition? Immediately following the dislocation circa 2013-2014, requiring emergency medical care and hospitalization for several days. [CHART REVIEW.docx]
When was the condition confirmed/formally diagnosed? Initially diagnosed circa 2013-2014 during emergency treatment and hospitalization; detailed history formally documented on 29 August 2011 by the treating doctor at the treating doctor Health Centre. [CHART REVIEW.docx]
When did the veteran first present to you (or your practice) for this condition? 08 May 2015
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.
The diagnosis was confirmed through clinical history and examination findings. Initial emergency treatment following traumatic injury confirmed the acute dislocation requiring immediate reduction and hospitalization. Subsequent comprehensive medical assessments documented ongoing symptoms consistent with post-traumatic joint dysfunction including chronic pain, functional limitations, and inability to kneel. Imaging in 2017 excluded current acute dislocation but confirmed ongoing soft tissue changes with trace fluid collections consistent with chronic post-traumatic changes. [CHART REVIEW.docx]
4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
Factor 9(1): having physical trauma to the affected joint at the time of the clinical onset of dislocation of a joint or subluxation of a joint - MET
- The veteran experienced significant physical trauma during mandatory infantry training at the School of Infantry resulting in knee dislocation with loss of consciousness, requiring emergency medical care and hospitalization for several days.
Factor 9(8): inability to obtain appropriate clinical management for dislocation of a joint or subluxation of a joint - MET
- While initial emergency treatment was provided, the ongoing chronic symptoms, functional limitations, and lack of comprehensive long-term rehabilitation suggest inadequate clinical management of post-traumatic complications.
Sequelae
Not applicable as this represents the primary traumatic injury that occurred during military training.
Unintended Consequence
No evidence of this condition being an unintended consequence of medical management. The condition resulted from traumatic injury during mandatory military training activities.
Inability to Attain Appropriate Medical Management
There was partial inability to attain appropriate medical management for this condition. While initial emergency treatment was provided including reduction and hospitalization, the ongoing chronic symptoms and functional limitations suggest inadequate long-term rehabilitation and management of post-traumatic complications. The veteran continues to experience significant functional limitations including inability to kneel for extended periods and pack marching difficulties, indicating inadequate restoration of function. As established in Brew v Repatriation Commission, this constitutes inability to obtain appropriate clinical management, causing permanent worsening through inadequate prevention and treatment of post-traumatic complications.
the % contribution of the causes is 100% and significant
5. Please provide a Health Summary and a medication/prescribing history. -see attached report
