Although often overlooked as commonplace or insignificant, an injury to the knee joint often results in severe, permanent disability and a lifetime of pain. When such an injury is the subject of a personal injury case, the trial attorney’s task is to demonstrate that devastation to a jury. From opening statement through summation, proving the nature and extent of the injury to the finder of fact is both critical and relatively straightforward.
The opening statement must lay out both the general anatomy and specific injury to the jury:
To understand how the injury affected the man, you have to understand the anatomy involved, as well as the specific injuries. James Jones sustained basically three injuries to his right knee: a torn medial meniscus, chondromalacia and a partial tear of the anterior cruciate ligament. To have a good idea of what these injuries mean, we have to first discuss the normal anatomy.
The knee joint is what’s known as a hinge joint. It is formed by the meeting or articulation of two large bones: the femur, or thighbone, the longest bone in the body; and the tibia or shinbone, a relatively long bone as well. The upper bone, or femur, at its lower end has what are known as the femoral condyles. These condyles fit into the grooves created by the meniscus or cartilage of the knee. Below the condyles and the meniscus is the top of the tibia, known as the tibial plateau. The knee is held together by four ligaments, which are like rubber bands which connect from bone to bone: the anterior cruciate ligament in the front center, the posterior cruciate ligament to the rear center and the collateral ligament on the inner side of the joint known as the medial collateral ligament, and the outer ligament or the lateral collateral ligament. The collateral ligaments give the joint stability from side to side; the cruciate ligaments give stability forward and rear. There are two meniscuses or menisci which we commonly refer to in lay terms as cartilage. These cartilagenous cushions work as shock absorbers of the knee joint: they protect the bones—the tibial plateau and the femoral condyles—from grinding against each other and allow the knee to flex and bend and withstand the forces of walking, running, jumping and bending. Without these menisci, the knee would become totally arthritic with bone constantly rubbing against bone.
The one thing that we haven’t touched upon is the front of the knee joint where there is a covering called the patella, commonly known as the knee cap. The knee is the largest weight-bearing joint in our body. So any injury to that area can not only cause severe pain, but inability to walk or sit or bend.
So let’s talk about the injuries: The torn meniscus or cartilage between the tibia and femur is quite severe. It is torn from its center up to the outer edge heading up toward the femoral condyles on the medial or inner side. Because it lies between these two large bones and is subjected constantly to the forces of walking and bending, it is now degenerative in nature. It tears more and more as Mr. Jones uses his knee. Because it has no significant blood supply to begin with, it cannot heal itself or regenerate. Thus, that meniscus is damaged forever. It will never get better. That cartilage was torn during the car accident. When Mr. Jones was broadsided, it caused the twisting of the femur over the tibia in a grinding motion and caused the tear. It is extremely painful.
Not only did he twist his knee, but he banged the front of that knee on the underside of the dash board. So that the knee cap or patella was severely bruised. That bruise healed, but what didn’t heal was the underside of the patella where the articular cartilage became softened and chopped up. That is what is known as chondromalacia. That is a particularly painful condition when he is forced to confront staircases and inclines. There is no cure for that other than surgical debridement or removing the dead and damaged tissue, by scraping the underside of the kneecap.
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