A new study published in the Journal of Bone and Joint Surgery may help establish reserve estimates for future medical care following meniscus transplant surgeries. While most patients younger than age 50 experienced reduced pain and improved knee function following transplant surgery, many patients required additional surgery within 10 years

The meniscus is a wedge-shaped piece of fibrocartilage in the knee that acts as a shock absorber between the thighbone and shinbone. For younger patients with knee pain after loss of the meniscus, a meniscus transplant is performed to maintain a cushion between the two bones. An orthopedic surgeon executes the knee surgery by using an arthroscope to accurately place and stitch new, transplanted meniscal tissue.

In the new study, researchers followed 38 meniscal transplant patients under age 50, who did not have arthritis, for an average of 11 years following surgery. The estimated probabilities of transplant survival were 88% at five years, 63% at ten years, and 40% at fifteen years. Worst-case survival rate estimates were 73% at five years, 68% at seven years, 48% at ten years, and 15% at fifteen years. The mean time to failure was 8.2 years for medial transplants and 7.6 years for lateral transplants.

“This data provides surgeons with reasonable percentages that encourage delaying additional major knee surgeries related to a damaged meniscus,” said Frank R. Noyes, MD, lead study author and founder of the Noyes Knee Institute at the Cincinnati Sports Medicine and Orthopaedic Center.

“However, the longer-term function of meniscus transplants remains questionable because the survivorship rate of the transplants decreases to between 40 and 15 percent at 15 years,” said Dr. Noyes. “Patients should be advised that this procedure is not curative in the long-term and additional surgery will most likely be necessary.”

A Santa Barbara-area physician who wrote numerous prescriptions for powerful painkillers, such as OxyContin, for “patients” – many of whom were drug addicts, and some of whom died from drug overdoses – was convicted after a jury trial on 79 drug trafficking charges. Julio Gabriel Diaz, 67, a Goleta resident who operated the Family Medical Clinic in Santa Barbara, was found guilty following a 2½-week trial in United States District Court. As a result of these verdicts, Diaz will face a maximum possible sentence of 1,360 years in federal prison. Diaz is scheduled to be sentenced on December 14.

Diaz, who was known to some “patients” as the “Candyman,” was a prolific writer of prescriptions for highly addictive and dangerous drugs. In 2011, for example, Diaz wrote prescriptions for more than 1.7 million doses of painkillers. His “patients” typically paid cash, waited hours for a 10-minute visit with Diaz, and received prescriptions for powerful drugs that included opioids, anti-anxiety medications and muscle relaxants. Several doctors and pharmacists who testified during the trial said that they had never seen any doctor prescribe the combination and quantity of drugs prescribed by Diaz.

Diaz was found guilty of 79 counts of distribution of a controlled substance. Twenty-six of the charges relate to oxycodone (a drug often sold under the brand name OxyContin), 10 of the charges relate to methadone, seven of the counts relate to hydromorphone (a drug commonly sold under the brand name Dilaudid), 10 of the charges relate to fentanyl, 11 of the charges relate to hydrocodone (a drug often sold under the brand names Vicodin and Norco), 10 of the charges relate to alprazolam (a drug often sold under brand name Xanax), and five of the charges related to the distribution of various controlled substances to a minor. In relation to all 79 counts, the jury found that Diaz distributed the drugs outside of the usual course of professional practice and without a legitimate medical purpose.

According to the evidence presented at trial, doctors, nurses and other personnel with Santa Barbara Cottage Hospital wrote to the Medical Board of California and gave statements to investigators to complain about Diaz. Cottage Hospital doctors believed that Diaz posed such a threat that they prepared a spreadsheet documenting emergency room visits by patients who had been prescribed narcotics by Diaz.

Diaz was arrested in this case in January 2012. After his arrest, the state of California revoked his license after finding that he provided incompetent and grossly negligent care.

A former Los Angeles County probation officer, Robyn Palmer, 29, of Long Beach, was arrested on six felony counts of insurance fraud for allegedly forging documents to illegally collect disability insurance benefits while serving probation for another insurance fraud conviction.

Palmer was arrested while serving five years’ probation following her conviction on 14 felony counts of insurance fraud, forgery, wire fraud, and grand theft in May 2014 for illegally collecting disability benefits from Allstate Insurance. Palmer was sentenced to five years’ probation and ordered to pay restitution in the amount of $31,122.

“Palmer’s nerve in allegedly collecting disability benefits fraudulently while serving probation for doing the same thing to another insurer is egregious,” said Insurance Commissioner Dave Jones. “Crimes like these are costly to business, consumers and California’s economy.”

Department of Insurance detectives were contacted by American Family Life Insurance Company (AFLAC) after the insurer identified suspected fraud by Palmer. The investigation revealed that Palmer was allegedly collecting disability benefits totaling $24,000 from AFLAC while being prosecuted for the first crime against Allstate and continued to do so after her conviction and while on probation.

Palmer is being held at the Century Regional Detention Center in Lynwood, CA in lieu of $150,000 bail. This case is being prosecuted by the Los Angeles District Attorney’s Office. If convicted, Palmer could be sentenced to five years in state prison.

On August 14, 2013, the WCJ in the case of Trinh v Tzeng Long USA Inc. issued an Order For Costs And Sanctions against Professional Lien Services, Inc., (PLS), ordering it to pay defendant’s costs and attorney’s fees in the amount of $2,355 along with a separate court sanction of $1,000. The sanctions were imposed for PLS’s bad faith and frivolous conduct in pursuing a trial on the issues of penalty and interest when it did not offer evidence at the trial adequate to meet its initial burden of proof.

Neither PLS nor its representative, Mike Traw petitioned for reconsideration or otherwise appealed the August 14, 2013 Sanction Order and it is now final and binding for all purposes.

Deputy Commissioner Rick Dietrich, Secretary of the Appeals Board, notified PLS in October 2013 that payment of the $1,000 court sanction was expected within ten days and further advised that failure to pay the sanction was grounds for suspending the privilege of appearing before the WCAB pursuant to section 4907. PLS replied that it was petitioning for reconsideration, but that was not the case.

Defendant also made unsuccessful efforts to recover the costs and attorney’s fees that PLS is obligated to pay as part of the Sanction Order. Thus the En Banc panel concluded “None of the efforts by the Appeals Board and the defendant have resulted in voluntary compliance with the August 14, 2013 Sanction Order by PLS and Mr. Traw, and it appears they are willfully disobeying the August 14, 2013 Sanction Order.”

Section 4907(a)(2) provides for suspension of the privilege of appearing before the WCAB for, “failure to pay final order of sanctions, attorney’s fees, or costs, issued under Section 5813.” The failure to comply with an order or regulation of the WCAB, including an order to pay a sanction, is an interference with the judicial process that provides good cause for suspending or removing the privilege of appearing before the WCAB.

For this reason it was ordered that “that the Appeals Board intends to suspend the privilege of Professional Lien Services, Inc., and Mike Traw of appearing before the Workers’ Compensation Appeals Board pursuant to Labor Code section 4907 for ninety (90) days unless good cause is shown why the suspensions should not be imposed.”

A new study published in the Annals of Internal Medicine and summarized by Reuters Health says that spinal epidural injections of steroids may relieve low back pain from a ruptured disc, but only briefly. And the injections offer no significant relief for pain related to narrowing of the spaces around the spinal cord, the researchers say. Some earlier studies have reached similar conclusions, but others have shown some benefit. Meanwhile, the use of epidural steroid injections has been increasing in the face of contradictory guidelines for physicians.

To clarify this confusing situation, Dr. Roger Chou from Oregon Health and Science University in Portland and colleagues sorted through the evidence from 63 published reports about the use of epidural steroid injections for treating low back pain from ruptured discs or spinal narrowing. “I think the important thing is for patients and clinicians to be able to make informed decisions,” Chou told Reuters Health by email. “Epidural corticosteroid injections are perceived as being more effective than they are.”

Spinal steroid injections brought immediate relief of pain and improvement in function in patients with ruptured discs, but not in patients with spinal narrowing, or stenosis, the researchers reported in Annals of Internal Medicine. Injections also seemed to reduce the need for disc surgery in the short term. But in the long term, the effects of injecting steroids epidurally were no better than the effects of a placebo, the researchers say, and there was no reduction in the need for surgery. It didn’t seem to matter what specific injection technique or which particular steroid was used.

The new analysis seems unlikely to settle any controversies, however. Dr. Zack McCormick, who specializes in physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine in Chicago, told Reuters Health by email that because the studies available for analysis by Chou’s team were of low quality, the conclusions “cannot be applied to the realistic day-to-day practice of spine medicine. The goal of epidural steroid injection is not for long term ‘cure,’ but rather to (improve) symptoms in order to allow restoration of sleep, quality of life, and tolerance of physical therapy,” McCormick said.

Dr. Laxmaiah Manchikanti from the University of Louisville, Kentucky, who is CEO and Chairman of the Board of American Society of Interventional Pain Physicians, was also skeptical, and he told Reuters Health by email that patients with lower back pain from a ruptured disk or spinal stenosis should talk to their physician rather than trust the new conclusions. “Over a million people receive epidural injections either with steroids or with local anesthetic alone per year and at least 60% of them receive significant relief,” he said.

Dr. Steven P. Cohen, a pain specialist at Johns Hopkins School of Medicine in Baltimore, Maryland told Reuters Health by email, “I do not think we should categorically discontinue epidural steroid injections for either of these conditions, but we need to limit their use to those people who are most likely to benefit, and to only repeat them if patients obtain clearly defined improvements in function and quality of life. Otherwise, the costs and risks may outweigh the benefits.”