Diagnostic Assessment — Right Knee - LCL Sprain
Example 1 of 1 · fictitious patient (Veteran N)
Diagnostic Assessment
Right Knee - LCL Sprain
SOP Codes: Balance of Probabilities - Sprain and Strain No. 28 of 2020; Reasonable Hypothesis - Sprain and Strain No. 27 of 2020
ADF History
The veteran, Chef (Army Catering Force), enlisted 09 January 2009, discharged 27 Mar 2016.
Occupational History
Military chefs are exposed to physical training activities including running, marching, and obstacle courses, manual handling of heavy kitchen equipment with potential for sudden movements and awkward positioning, working on uneven surfaces in field kitchens, participation in military exercises involving varied terrain, and sustained standing with frequent direction changes during food preparation. These activities predispose to knee ligament injuries through sudden loading, pivoting movements, and traumatic episodes.
History
The veteran the veteran a military chef, sustained a right knee lateral collateral ligament sprain during his service in the Australian Defence Force from February 2011 to Apr 2018, likely through a specific traumatic episode during military training or occupational activities.
Timeline
- 29 December 2018 - MRI bilateral knee revealed evidence of previous traumatic injury to the right knee. The imaging demonstrated subtle scarring of the proximal aspect of the right lateral collateral ligament suspicious for old sprain injury. The radiologist's impression specifically documented subtle region of scarring involving the proximal aspect of the right lateral collateral ligament suspicious for old sprain injury. The presence of scar tissue formation indicates a previous significant ligamentous injury that has healed with fibrous tissue replacement, representing permanent structural changes from the original sprain. The unilateral nature of the scarring suggests a specific traumatic episode during military service rather than bilateral degenerative changes.
Symptoms
Current symptoms include lateral knee instability and discomfort with activities involving lateral stress to the knee joint. The chronic scarring of the LCL may cause functional limitations with pivoting movements and activities requiring knee stability. The condition can predispose to further knee injuries due to residual ligamentous weakness.
Imaging
29 December 2018 - MRI bilateral knee revealed subtle scarring of the proximal aspect of the right lateral collateral ligament suspicious for old sprain injury. The impression documented subtle region of scarring involving the proximal aspect of the right lateral collateral ligament suspicious for old sprain injury and noted no meniscal or cruciate ligament pathology.
1. What is the formal diagnosis of the condition claimed above?
Right Lateral Collateral Ligament Sprain with Chronic Scarring. SOP: Sprain and Strain No. 28 of 2020. ICD-10: S83.42.
A sprain means an injury involving the tearing or stretching of one or more joint ligaments, associated with the onset of pain and tenderness at that site within the 24 hours following the injury. The lateral collateral ligament provides stability to the lateral aspect of the knee joint, preventing excessive varus angulation and rotation. Sprain injuries result from forces that exceed the tensile strength of the ligament, causing microscopic or macroscopic tearing with subsequent healing through scar tissue formation.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? Unknown specific date during military service 2013-2020. [Chart Review Document, multiple pages - specific injury date not documented in available records]
When did the veteran first present to a health / medical provider for this condition? 24 September 2018 for DVA assessment with Dr Thomas Perkins, General Practitioner. [Email - General & Service Details.pdf, page 1]
When was the condition confirmed / formally diagnosed? 29 December 2018 by the treating doctor, Radiologist, through MRI bilateral knee imaging showing chronic scarring. [Imaging.pdf, page 1]
When did the veteran first present to you (or your practice) for this condition? 19 July 2018
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 by MRI imaging conducted by Radiologist the treating doctor on 29 December 2018. The imaging revealed subtle scarring of the proximal aspect of the right lateral collateral ligament suspicious for old sprain injury. The radiologist's impression specifically noted the subtle region of scarring involving the proximal aspect of the right lateral collateral ligament suspicious for old sprain injury, indicating previous ligamentous trauma with healing through scar tissue formation. [Imaging.pdf, page 1 - link to imaging report]
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.
Experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament - MET
- Military service activities including physical training, obstacle courses, field exercises, and occupational activities involving heavy lifting and manual handling provided multiple opportunities for significant physical forces to be applied through the knee joint, resulting in LCL sprain
Forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon - NOT MET
- This factor applies to muscle/tendon strain rather than ligament sprain
Experiencing a significant physical force applied to or through the affected joint, at the time of the clinical worsening of a sprain to that joint ligament - MET
- Ongoing military activities and occupational demands could have caused further stress to the previously injured LCL, contributing to permanent scarring and chronic changes
Forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon - NOT MET
- This factor applies to muscle/tendon strain rather than ligament sprain
Inability to obtain appropriate clinical management for sprain or strain - MET
- No documented treatment or management of the LCL sprain during military service, with formal diagnosis only occurring in February 2021, representing significant delay in appropriate clinical management as per Brew v Repatriation Commission precedent
Sequelae
This condition is not a sequelae of another known condition but represents primary ligamentous injury from military service activities.
Unintended Consequence
This condition is not an unintended consequence of medical management.
Inability to Attain Appropriate Medical Management
There was inability to attain appropriate medical management. The condition was not diagnosed until February 2021, representing a significant delay from the period of military service (2013-2020) when the injury occurred. The Full Federal Court in Brew v Repatriation Commission (07 July 1993) establishes that "inability" encompasses both objective and subjective barriers to obtaining treatment. The absence of documented presentations for knee ligament injury during military service indicates barriers to healthcare access, satisfying the inability to attain appropriate medical management factor. This delay in diagnosis and treatment has caused permanent worsening of the condition, as early intervention with immobilization, physiotherapy, and activity modification could have prevented the formation of excessive scar tissue and maintained better ligamentous function.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
