(a) the Motor Accident Guidelines issued under s 10.2 of the Act;

(b) relevant principles of causation and reasonableness under the Act, and

(c) the clinical judgment and specialist experience of the Medical Assessors.

1. The Review Panel was provided with an extensive Joint Bundle of documents dated

15 May 2025, which included the claimant's and insurer's submissions, clinical and radiological records, medico-legal reports, insurer determinations, and previous medical assessments. The Panel has carefully reviewed all materials. What emerges is a medically complex and procedurally layered narrative involving a claimant with long-standing mechanical knee symptoms following a high-impact motor vehicle accident, in the context of pre-existing but relatively quiescent degenerative joint disease.

1. The claimant advanced submissions dated 12 June 2024 seeking approval for right knee arthroscopy and MRI imaging. It was submitted that these interventions were supported by treating specialists and reflected a clinically appropriate escalation of care in the context of the claimant's deteriorating symptoms and limited response to non-operative management.
2. The insurer filed reply submissions on 5 July 2024. It contended that the pathology in the right knee was predominantly or wholly degenerative in origin, and that the proposed surgery lacked a sufficient prospect of benefit to be considered reasonable. Reference was made to divergent medical opinions and to the temporal development of symptoms.

(a) 30 January 2024: Request for arthroscopic surgery declined.

(b) 22 February 2024: MRI right knee declined on the basis that it was not accident-related.

(c) 15 February and 28 February 2024: Internal reviews affirmed both decisions.

1. Notably, in the second internal review, the insurer accepted that the claimant's knee injury was causally related to the accident but declined to authorise the MRI on the basis that it was unlikely to change management. That shift in position, from disputing causation to disputing utility, is of significance in the overall evidentiary matrix.

1. Dr David Lieu, orthopaedic surgeon, examined the claimant on multiple occasions. In his initial report dated 26 May 2021, he identified a posterior horn/root tear of the medial meniscus with associated loose bodies and mechanical symptoms. He described the injury as superimposed upon pre-existing arthritis, and recommended arthroscopy as a means of improving pain and function. Dr Lieu later reaffirmed this view in 2023 and 2024, noting that while the claimant's arthritis would persist, surgery might still provide targeted relief of the unstable meniscus tear and facilitate return to heavier work duties.
2. Dr George Konidaris, also an orthopaedic surgeon, reviewed the claimant in 2022. While he acknowledged the traumatic origin of the root tear and its contribution to accelerating joint degeneration, he was more equivocal regarding the benefit of arthroscopy, estimating only a 30% chance of symptomatic improvement. He considered that the claimant's weight and constitutional factors were also relevant to disease progression and ultimately recommended conservative management. He did not, however, suggest that the proposed surgery was clinically inappropriate per se.
3. Thus, both surgeons identified pathology plausibly connected to the accident, but diverged in their assessment of whether surgical intervention was sufficiently likely to improve the claimant's condition.

1. Dr Andrew Keller, occupational physician, was engaged by the insurer. In his reports dated 18 October 2023 and 19 December 2023, Dr Keller opined that the claimant's symptoms were best understood as a manifestation of longstanding tricompartmental osteoarthritis. He acknowledged the accident may have temporarily exacerbated pre-existing disease but considered that any such exacerbation would have resolved within three to six months. He expressed scepticism that the meniscal tear was traumatic in origin, and he did not support surgical or further imaging interventions, describing them as unlikely to alter the claimant's course.
2. Dr Keller's view stood in contrast to those of both treating surgeons, particularly in respect of causation. His opinion relied heavily on imaging studies conducted within months of the accident, which he interpreted as showing advanced chronic changes inconsistent with acute trauma.

1. The Panel had regard to all available imaging studies of the claimant's right knee, including pre-accident, early post-accident, and more recent imaging. These investigations document the evolution of the claimant's intra-articular pathology and provide critical context for assessing both causation and the appropriateness of the proposed treatment:

(a) CT right knee - 7 October 2014: This pre-accident CT scan reported "some minor osteoarthritis with some minor osteophytic ridging of the medial margin of the tibial eminence and some minimal subchondral sclerosis within the medial femoral condyle and medial tibial plateau," as well as a small joint effusion.

(b) X-ray right knee - 8 October 2014: Performed one day later, this x-ray demonstrated "minimal asymmetric loss of medial tibiofemoral joint space height with weight bearing," with no significant osteophytosis or suprapatellar effusion.

(c) X-ray right knee - 22 January 2021: Shortly after the accident, this x-ray showed "mild mainly medial tibiofemoral osteoarthritis" but no acute bony injury or joint effusion. This confirms the persistence of underlying degenerative changes, albeit stable when compared with the 2014 studies.

(d) MRI right knee - 5 May 2021: This post-accident MRI was a pivotal diagnostic investigation. It demonstrated: "High-grade partial thickness tear or full thickness tear involving the posterior root ligament junction of the medial meniscus. Tricompartmental degenerative changes with articular cartilage wear and fissuring. At least two cartilaginous loose bodies in the anterior joint." These findings were relied on by both treating surgeons, with particular emphasis on the posterior root tear and loose bodies as surgical targets.

(e) MRI and X-rays - 10 August 2022: This repeat MRI described "marked attenuation of the posterior root ligament at the junction of the posterior horn and posterior root ligament of the medial meniscus," and noted that this "may represent previous partial meniscectomy or chronic tear." Also reported were mild medial and patellofemoral arthrosis, a small joint effusion, chondrobasal delamination involving the lateral femoral condyle. These findings reflect progressive degenerative changes, while reaffirming the persistence of meniscal root pathology.

(f) MRI right knee - 25 March 2025 The most recent MRI showed: "Mild undersurface fraying and tearing of the posterior horn and body of medial meniscus with mild medial extrusion. Moderate medial tibiofemoral and mild patellofemoral compartment degeneration. Small joint effusion. Mild myxoid degeneration of the ACL."

1. Across all imaging series from 2021 to 2025, the posterior horn/root tear of the medial meniscus is a consistent feature. While degenerative changes are also well documented, particularly in the medial compartment, the presence of cartilaginous loose bodies, mechanical derangement, and an evolving effusion pattern all support the clinical picture of symptomatic intra-articular pathology likely precipitated or aggravated by the traumatic event.
2. The pre-accident imaging from 2014 supports that the claimant had only mild degenerative changes prior to the accident. There is no intervening imaging between 2014 and the 2021 studies. The Panel accepts that the radiological trajectory from 2021 onward is consistent with either trauma-induced degeneration or trauma superimposed on quiescent degeneration, particularly in light of the early appearance of a high-grade meniscal root tear following the collision.

1. The claimant's GP and allied health records were also reviewed. They document the onset of right knee pain shortly after the accident, ongoing functional impairment, reduced mobility, and poor response to physiotherapy and corticosteroid injection. Clinical notes spanning 2021 to 2025 consistently refer to mechanical symptoms, including clicking, instability, antalgic gait, and night pain. Several certificates of capacity describe significant impact on the claimant's ability to work, particularly in his pre-accident role as a car spray painter.
2. The records reveal no documented episodes of right knee pain in the five years preceding the accident, notwithstanding a prior imaging series in 2014 which showed only mild degenerative change. This absence of contemporaneous complaints prior to 2021 is a notable feature of the chronology.

1. The Panel is required to determine whether the proposed right knee arthroscopy and MRI imaging are both related to the injury caused by the motor accident on 9 January 2021 and reasonable and necessary in the circumstances, pursuant to cls 1.4 and 3.24 of the Act.

1. The Panel accepts, on the totality of the evidence, that the claimant sustained a significant injury to the posterior horn and root of the medial meniscus of the right knee as a result of the motor accident. The claimant was stationary in his vehicle when struck from behind with sufficient force to push his vehicle into the one in front. Although he did not require hospitalisation, clinical records document right knee pain and swelling within days of the accident. There is no evidence of an intervening traumatic event.
2. Radiological imaging obtained shortly after the accident specifically the MRI of

5 May 2021 confirmed the presence of a high-grade tear at the posterior root junction, in addition to chondral degeneration and intra-articular loose bodies. That pattern is characteristic of an acute meniscal root tear superimposed on background osteoarthritic change, a point expressly noted by treating surgeon Dr Lieu. 3. While the claimant had pre-existing radiological signs of mild osteoarthritis dating back to 2014, there were no documented complaints of right knee pain in the intervening five years. The Panel considers this quiescence to be inconsistent with the insurer's contention that the claimant's symptoms are entirely constitutional. Furthermore, both Dr Lieu and Dr Konidaris accepted that the posterior root injury likely resulted from the accident and that it contributed to subsequent functional deterioration. 4. Although Dr Keller, the insurer's medical expert, opined that the pathology was degenerative and not traumatic, the Panel does not accept that opinion in preference to the consistent clinical picture, the chronology of symptom onset, and the MRI findings. The insurer itself ultimately conceded in its 28 February 2024 internal review that the meniscal injury was causally related to the subject accident. 5. The Panel finds that the medial meniscus root tear was caused by the motor vehicle accident, and that subsequent degeneration has occurred, at least in part, as a sequela of that injury.

Reasonableness and necessity of arthroscopic surgery

1. In assessing whether the proposed arthroscopy is reasonable and necessary, the Panel has considered the opinions of the treating orthopaedic surgeons, the nature and persistence of the claimant's symptoms, the failure of non-operative measures, and the prospect of material benefit from the proposed intervention.
2. Dr Lieu first recommended arthroscopy in May 2021 following unsuccessful physiotherapy and corticosteroid injection. He reaffirmed that opinion in October 2023, noting persistent mechanical symptoms and the presence of loose bodies and an unstable meniscal tear.

Dr Lieu's reports consistently identified a discrete structural pathology that was amenable to surgical inspection and debridement. 3. Although Dr Konidaris was more guarded, he did not suggest that surgery was inappropriate, but rather that the likelihood of improvement was modest. His estimate of a 30% chance of benefit reflects clinical caution, but not futility. He also acknowledged that the accident contributed to the claimant's progressive symptoms. 4. Dr Keller opposed the surgery, citing the presence of tricompartmental osteoarthritis and limited anticipated benefit. However, his assessment appeared to discount the mechanical dimension of the injury and did not address the claimant's ongoing instability, audible clicking, and functional restriction. 5. The Panel is satisfied that, notwithstanding the background of degenerative change, the meniscal tear constitutes a discrete surgical target, and that the proposed arthroscopy is an accepted and reasonable intervention in such circumstances. The presence of persistent mechanical symptoms after non-operative treatment supports the conclusion that the procedure is reasonable and appropriate. 6. In reaching this conclusion, the Panel recognises that surgery is not guaranteed to succeed, but the standard under the Act is one of reasonableness, not certainty of benefit. The Panel finds that the procedure is reasonable and necessary in the circumstances and has a sufficient prospect of ameliorating pain and restoring function.

1. The proposed MRI of the right knee was requested in February 2024, nearly 18 months after the claimant's last imaging. At that point, the claimant's symptoms had continued to deteriorate, and a decision as to whether surgery remained appropriate required up-to-date radiological information. Indeed, both Dr Lieu and the insurer ultimately relied on MRI studies in assessing treatment options.
2. The insurer denied the MRI on the basis that it would not change the treatment plan. However, this submission is inconsistent with the accepted clinical practice of reviewing updated imaging prior to undertaking surgery in a joint with progressive pathology. The insurer's own internal review acknowledged that the injury was causally related but declined the MRI on utility grounds alone.
3. In the Panel's view, the requested MRI was a rational and necessary adjunct to surgical planning. It allowed the treating specialist to assess the progression of chondral loss, meniscal degeneration, and joint effusion. These are factors directly relevant to operative risk and expected outcome.
4. The Panel finds that the MRI imaging was reasonable and necessary in the circumstances and causally related to the injuries sustained in the motor accident.

1. Having regard to the totality of the evidence and for the reasons given above, the Panel is satisfied that the claimant sustained a significant injury to the right knee as a result of the motor vehicle accident on 9 January 2021, namely a posterior horn and root tear of the medial meniscus, accompanied by intra-articular loose bodies and progressive symptomatic deterioration.
2. The Panel finds that this injury is causally related to the subject accident and that the proposed arthroscopic procedure involving debridement, removal of loose bodies and partial medial meniscectomy is reasonable and necessary in the circumstances. While the claimant's pre-existing tricompartmental osteoarthritis may diminish the prospect of complete recovery, it does not displace the reasonableness of surgical intervention aimed at addressing discrete mechanical pathology which continues to impair the claimant's function and capacity.
3. The Panel further finds that the request for updated MRI imaging of the right knee was likewise reasonable and necessary, having regard to the progression of symptoms, the temporal distance from prior imaging, and the need for up-to-date information to inform surgical planning. The imaging was clinically appropriate and aligned with standard orthopaedic practice in circumstances where operative management remained under consideration.
4. Accordingly, the Panel determines that the certificate issued by Medical Assessor Bodel on

1. Pursuant to s 7.26(7) of the Act_,_ the Review Panel determines as follows:

(a) The Review Panel determines that the proposed right knee arthroscopic surgery, as requested by the claimant's treating orthopaedic surgeon, is:

(i) related to the injury resulting from the motor accident on 9 January 2021, and

(i) reasonable and necessary in the circumstances.

(b) The Review Panel further determines that the MRI imaging of the right knee requested in February 2024 is:

(i) related to the injury resulting from the motor accident on 9 January 2021, and

(i) reasonable and necessary in the circumstances.

(c) Accordingly, the certificate of Medical Assessor Bodel dated 9 February 2025 is affirmed.