Case details

Degenerative knee changes not caused by collision: defense





Result type

Not present

chondromalacia, chondromalacipatellneck, knee, medial meniscus, tear
On Nov. 5, 2015, plaintiff Jorge Rincon-Balbuena, 35, a carpet cleaner, was stopped in traffic on U.S. Route 101, also known as the Hollywood Freeway, at the Cahuenga Pass, in Los Angeles, when his cargo van was struck on the right, rear corner by a hybrid vehicle operated by Silva Terzyan. Rincon-Balbuena claimed to his neck, back and right knee. Rincon-Balbuena sued Terzyan and the owner of the hybrid vehicle, Anahit Poturyan. Rincon-Balbuena alleged that Terzyan was negligent in the operation of her vehicle and that Poturyan was vicariously liable for Terzyan’s actions. Poturyan was dismissed from the case, and Terzyan admitted liability for the accident., Rincon-Balbuena claimed he sustained soft tissue sprains and/or strains of his neck and back, and a medial meniscus tear in his right knee. He was not taken to a hospital from the scene, but later presented to a chiropractor with complaints of pain in his lower back and right knee. Rincon-Balbuena was started on a physical therapy program, which he allegedly benefited from. He also had multiple follow-up visits, during which he demonstrated gradual improvement from his subjective complaints with the exception of his right knee. Rincon-Balbuena was then referred to an expert orthopedic surgeon as a result of his continuing knee complaints. Rincon-Balbuena missed one week from his employment before returning to work as a carpet cleaner. On Dec. 1, 2015, Rincon-Balbuena underwent an MRI of the right knee at Shin Imaging Center, in Los Angeles. He was also examined his treating expert orthopedic surgeon, who felt there was no strict indications for surgery and recommended that Rincon-Balbuena continue with conservative treatment before contemplating surgery. However, by May 13, 2016, Rincon-Balbuena complained of pain in his right knee being greater than his left, which he rated as an eight out of 10 and as being present intermittently. The plaintiff’s expert orthopedic surgeon performed a diagnostic arthroscopy and partial medial meniscectomy on the right knee on Sept. 6, 2016. During the surgery, it was found that there was a complex tear of the posterior horn of the medial meniscus, comprising about 20 percent of the meniscus, which required resection (removal) of 20 percent of the meniscus medially. The post-operative diagnosis was chondromalacia of the right knee’s trochlea and a traumatic, complex tear of the right knee’s medial meniscus. Rincon-Balbuena followed up with his treating orthopedist 10 days after the surgery, during which time the doctor informed Rincon-Balbuena about having to remove a significant part of the meniscus during the surgery (meniscectomy), instead of simply repairing the meniscus. Rincon-Balbuena then began physical therapy. He also received post-operative chiropractic care from a chiropractor at Palmdale Chiropractic, where he was seen on multiple occasions throughout September, October, November and December of 2016. Rincon-Balbuena was last seen on Dec. 6, 2016, which was three months post-operation and more than one year post-injury. At that time, he claimed that his lower back pain was getting better with a pain level of a three out of 10. Rincon-Balbuena also claimed that physical therapy and medications were helpful and that his right knee was better, with his walking tolerance becoming more than 1 hour. An examination of the knee revealed no effusion (swelling) with only minimal joint line tenderness. Rincon-Balbuena was also noted to be able to fully squat with some medial knee pain. As a result, he was released by his treating orthopedic expert. The plaintiff’s treating orthopedic surgery expert testified that, based on the information available to him on Dec. 30, 2016, the injury to Rincon-Balbuena’s right knee was solely related to the subject motor vehicle accident. The expert also testified that he was based his opinion on his being told that there was no history of right knee pain or problems prior to the subject accident, and based on there being documented complaints of right knee symptoms shortly after the accident. While the expert noted that a rear-end collision was not classically known for causing a knee injury, Rincon-Balbuena reported that his foot was on the brake at the time of the collision. The treating orthopedic surgeon also opined that the MRI and operative findings were consistent with a traumatic medical meniscus tear, and he noted that the contralateral left knee had no problems documented following the accident. Rincon-Balbuena testified in his deposition that if he sits or kneels too long, his right knee will hurt and develop a burning sensation. He considered 20 minutes of kneeling too long. Rincon-Balbuena also admitted that he no longer has any residual lower back pain. Rincon-Balbuena sought recovery of $465,681.97 in total damages, including $66,831.93 in past medical costs (inclusive of chiropractic treatment, radiology, an MRI, treatment with the expert orthopedic surgeon, and anesthesia), $100,000 in non-economic damages for his past pain and suffering, and $300,000 in economic damages for his future pain and suffering. Defense counsel argued that Rincon-Balbuena’s were pre-existing and degenerative and that the were not of an acute, traumatic nature caused by the subject accident. Counsel contended that the Dec. 1, 2015 MRI of Rincon-Balbuena’s right knee revealed moderate effusion (fluid), a sprain of the anterior cruciate ligament, minimal osteophytes of the medial and lateral tibial plateau, a full thickness fissure in the articular cartilage of the central trochlea groove, chondromalacic changes of the medial femoral condyle, and intrasubstance degeneration in the mid-medial meniscus. As such, defense counsel argued that there was significant evidence of longstanding degenerative changes in the knee. Defense counsel asked the jury to only award Rincon-Balbuena between $11,716.76 and $34,913.99.
Superior Court of Los Angeles County, Santa Monica, CA

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