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The Expert: Dr. Michael Zeide, an orthopedic surgeon in Florida, testifies for the defense and concludes that the knee injury the plaintiff complains of did not occur in the collision.
Offering testimony in a 2021 Florida personal injury trial, a West Palm Beach orthopedic surgeon, Dr. Michael Zeide, testifies for the defense and concludes that the knee injury suffered by the plaintiff did not occur during the rollover collision. Answering the defense attorney in a very methodical way and utilizing anatomical props, the doctor counters the plaintiff’s contention.
He begins with unequivocal statements evaluating the plaintiff’s early signs, symptoms, and complaints. There were no complaints to any emergency room personnel, including triage, nursing or physicians, regarding the knee in question. There were no findings recorded regarding his knee examination in the emergency room. No X-rays were done of the knee and no crutches were provided when the plaintiff left the emergency room.
The patient was seen in follow-up by a treating physician, who Zeide reports, noted no complaints or findings regarding the knee in his records. Instead, the patient had complained to the treating physician of lower back pain and lower stomach pain. This had caused difficulty sleeping and stomach discomfort, but the doctor had not recorded any mention of the affected knee. As part of the back examination, the treating doctor examined the strength and reflexes of the extremities for nerve injury, and the findings were normal. This examination requires striking the knee with a reflex hammer as well as other manipulations, yet at no time did the plaintiff voice discomfort in the knee in question.
An acute tear of the anterior cruciate ligament (ACL), as would later be claimed, would manifest with swelling, discoloration, discomfort, and instability of the knee joint anteriorly. The treating doctor did not record any such findings or complaints from his patient, and in fact striking the knee with a reflex hammer over the area of the ACL did not elicit a painful response. Based upon these reports and his review of the MRI, Zeide states that the plaintiff had not sustained an ACL or meniscus tear as a result of this motor vehicle accident.
A tear of the ACL would allow the knee to glide forward without restraint. This hypermobility causes impingement of the bony tibial plateau upon the bony femoral condyle, an action which will “shred” the menisci of the knee.
The articular cartilage of the knee lacks a blood supply that will allow it to heal if injured. As the stresses of a knee lacking an intact ACL damage and soften the cartilage of the joint [chondromalacia], the cartilage becomes worn down in stages. In the late stages, there is no more cartilage and the grinding adjacent bones begin to develop arthritis. This process takes 10 or 15 years to develop. Chondromalacia was noted by the operating physician when the patient was eventually operated upon, so Zeide concludes that any injury to the plaintiff’s knee occurred well before this accident and took years to develop into chondromalacia. This is supported by the lack of complaints or findings in the knee at the time of the accident, in the emergency room, or days later in the treating physician’s office.
When the plaintiff eventually complained about the knee to another orthopedist whose chart was reviewed, his complaints involved the back of the knee. The expert testifies that if there had been a problem related to an ACL tear or meniscus damage, the complaints would be in the front or sides of the knee. The doctor examining the plaintiff at that time diagnosed a “posterior capsular disruption.” Zeide expressed consternation at this diagnosis when asked about it. He states flatly that he does not know what this is. “It is not in the anatomy books,” he exclaims.
The judgment favored the defense.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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