Overview for NSW injured workers
Start with the dispute, not just the diagnosis
May be relevant when
Benefits to check
Legal help is useful when
How this affects your claim in practice
In a patella injury claim, the diagnosis is only the starting point. The records should connect knee MRI or X-ray and orthopaedic report with the worker's practical limits, including standing, walking, stairs, kneeling, squatting, driving and load carrying and safe duties that avoid unsafe mobility demands. If the insurer disputes whether symptoms are due to arthritis only, the response should address that reason directly.
Assessment source
- NSW Guidelines for the Evaluation of Permanent Impairment, paras 1.8-1.12: NSW Guidelines control the assessment method and AMA5 is used only where adopted and not modified.
- NSW Guidelines para 1.12: AMA5 Chapter 18 pain is excluded; chronic pain is assessed through the underlying diagnosed condition, while CRPS is assessed under the relevant NSW method.
- NSW Guidelines para 1.15: assessment should usually wait until maximum medical improvement, meaning the condition is stable and unlikely to change substantially in the next year.
- NSW Guidelines Chapter 3 applies AMA5 Chapter 17 only as modified by NSW. Paragraphs 3.2-3.7 require the most specific valid method, selection of the highest valid evaluation where more than one method applies, common units before combination, and a 40% WPI lower-limb maximum.
- NSW Guidelines para 1.24: activities of daily living must not be used to increase or reduce a calculated lower-extremity impairment. Functional examples explain the measurement; they are not an extra percentage.
- NSW Guidelines paras 3.8-3.15 and corrected AMA5 Tables 17-4 and 17-6: true leg length, gait, unilateral atrophy and manual muscle testing each have their own measurement and non-combination requirements.
- NSW Guidelines paras 3.16-3.18: inconsistent range-of-motion findings are invalid; values from different movement planes within one joint are added; joint ankylosis uses the corrected NSW optimum-position table and positional additions.
- NSW Guidelines paras 3.19-3.24: arthritis means radiological cartilage loss for impairment purposes. It cannot be assumed from pain, and the arthritis method cannot be combined with gait, atrophy, strength or range of motion.
- NSW Guidelines paras 3.10-3.15 and 3.32-3.35: gait is a last resort; gait, atrophy, muscle testing and peripheral-nerve methods can duplicate lower-limb function and must follow Table 17-2 non-combination rules; CRPS uses the NSW Chapter 17 method rather than AMA5 Chapter 18 pain.
- NSW Guidelines paras 3.26-3.30 and Tables 3.2-3.4: NSW modifies diagnosis-based estimates, tibial plateau fracture, patello-femoral and ankle replacement, tibia-os calcis angle and persistent plantar fasciitis. Hip and total-knee replacements use AMA5 Tables 17-33 to 17-35 subject to the NSW corrections.
What injuries or conditions may be assessed?
Patella injuries include fracture, traumatic dislocation or translocation, recurrent instability, chondral damage, quadriceps or patellar-tendon disruption and post-traumatic patello-femoral arthritis.
- Anterior knee pain or crepitus is not a standalone percentage unless the narrow NSW criteria and permitted method are satisfied.
- The stable method may involve fracture, movement, instability or radiological cartilage loss. An isolated patello-femoral replacement is a separate postoperative method.
Symptoms and findings that matter
The file should identify direct anterior trauma or documented patellar dislocation/translocation, fracture alignment, movement, instability and radiological cartilage loss. Pain or crepitus alone does not select a table row.
For patella injury, range of motion is normally measured three times in each relevant plane and the greatest valid result is used. If repeated readings or findings between examinations are materially inconsistent, ROM is not a valid impairment parameter.
If true leg length is relevant to patella injury, manual measurement is an exception to the greatest-reading rule: three readings are averaged. The opposite joint or limb is also compared where it provides a valid baseline.
Where patella injury is assessed through manual muscle weakness, the examiner uses the six Medical Research Council grades from 0 to 5. Those grades are ordinal rather than evenly spaced, and the NSW method uses AMA5 Table 17-8; electrodiagnostic results do not replace the manual muscle test.
An impairment report for patella injury may need a diagnosis-based estimate, radiological cartilage-loss method, replacement score, true limb-length difference, unilateral atrophy, muscle grade, named-nerve deficit or gait method instead of, or in a limited case alongside, ROM.
What investigations are usually relevant
Investigations for patella injury may include weight-bearing X-rays, CT, MRI, ultrasound or operation records identifying the actual joint, fracture, tendon, ligament, cartilage, prosthesis or nerve condition and repeat goniometer measurements, stability tests, alignment findings and comparison with the unaffected side where that comparison is valid. Each result should answer a defined clinical question and be read with the examination, diagnosis and history.
- Orthopaedic, rehabilitation and physiotherapy records showing whether the condition has reached maximum medical improvement.
- Certificates of capacity and duties evidence about walking, standing, stairs, kneeling, squatting, driving, lifting and uneven ground. These explain claim impact but do not alter the WPI calculation.
How WPI is assessed for this body part
For patella injury, NSW Guidelines Chapter 3 applies AMA5 Chapter 17 subject to NSW corrections. The most specific valid method is used, and where more than one valid method applies the highest valid evaluation is generally selected unless Table 17-2 permits a combination.
If ROM is valid for patella injury, values in different planes of the same joint are added. Regional values in the same limb are expressed in the same unit and combined before conversion to WPI.
For patella injury, knee flexion means bending and extension means straightening. A flexion contracture prevents full passive and active straightening; an extension lag prevents active full extension despite greater passive extension. Varus and valgus describe inward or outward alignment.
Arthritis in an assessment of patella injury requires radiologically measured cartilage loss. For a knee, only the most impaired compartment is used. Arthritis cannot be combined with gait, atrophy, strength or ROM for the same loss.
For patella injury, gait remains a last-resort standalone method. Atrophy, manual muscle testing, peripheral nerve impairment and gait can duplicate strength loss and cannot be stacked. A diagnosis-based estimate is combined only where Table 17-2 permits it.
The calculation for patella injury cannot be changed because of activities of daily living under NSW paragraph 1.24. Functional descriptions help explain the evidence but are not an uplift or deduction.
Table and value examples
Patello-femoral pain or crepitation
No standalone percentage quoted here; use only when the NSW footnote criteria are metThe item is limited to direct anterior knee injury or patellar translocation/dislocation circumstances and cannot be added to a knee arthritis assessment.
Source: NSW Guidelines para 3.24 correction to AMA5 Table 17-31
Cartilage resurfacing procedures
No additional impairmentNo extra WPI is awarded for resurfacing procedures used for localised cartilage lesions and defects in major joints.
Source: NSW Guidelines para 3.28
Worked assessment illustrations
These examples paraphrase the assessment reasoning in the source material. They explain method only and are not predicted outcomes.
Illustration 1
Patella injury: choose the supported residual method
Assumed facts: Assume a traumatic patellar dislocation is accepted and the condition has stabilised. Examination records the residual stability and movement, while weight-bearing imaging addresses the patello-femoral cartilage interval.
Method: The assessor calculates each valid permitted method separately. Patello-femoral pain or crepitus is used only within the narrow NSW footnote circumstances and is not added to a knee-arthritis value.
Illustrative outcome: The highest valid permitted method is selected from the actual findings. A dislocation history or anterior knee pain does not produce an automatic percentage. This is an illustration only.
Source: NSW Guidelines paras 3.2-3.7 and 3.19-3.28; AMA5 Tables 17-2, 17-31 and 17-33 as modified
What usually does not increase WPI
Pain, tenderness, swelling or difficulty walking does not create a percentage without a valid lower-limb method.
A scan label, surgery name or recommendation for surgery is not a fixed WPI result.
Work restrictions, weekly payments and inability to resume the pre-injury job are important claim issues but are not themselves impairment measurements.
Activities of daily living cannot be used to increase or reduce the calculated lower-extremity rating.
Evidence checklist
The records for patella injury should include the accepted injury description, date and any insurer decision limiting the body part or diagnosis and imaging and operation reports, including the relevant side, level, compartment and procedure. They are most useful when the diagnosis, examination and practical restrictions are consistent.
- Repeat movement, stability, alignment, circumference, limb-length or neurological measurements required by the selected method.
- A calculation worksheet identifying the table, regional unit, permitted combinations, conversion and rounding.
How this injury commonly happens at work
Work-related patella injury can arise through twisting while loaded and kneeling or squatting. The chronology should identify the actual task or event and when symptoms or function changed.
Work-related patella injury can arise through falls on stairs or uneven ground and forceful pivoting or direct knee impact. The chronology should record the actual task or event and the point at which symptoms or function changed.
Common insurer disputes
For patella injury, an insurer may dispute whether symptoms are due to arthritis only and whether surgery or replacement is work-related. The written decision should be answered with evidence directed to those reasons.
Further disputes about patella injury may concern whether kneeling, stairs and standing duties are realistic. The decision notice should identify which issue is relied on and the evidence said to support it.
Treatment and surgery issues
Depending on the diagnosis and treating opinion, management of patella injury may involve physiotherapy, bracing, injections, arthroscopy, reconstruction or replacement where clinically supported. The request should explain the expected functional benefit and its connection to the accepted injury.
Weekly payments and work capacity
Capacity evidence for patella injury should address standing, walking, stairs, kneeling, squatting, driving and load carrying and safe duties that avoid unsafe mobility demands. Proposed duties must be sustainable for the proposed hours, not merely possible once.
For patella injury, capacity evidence should address travel to work and medication effects where relevant and weekly payment decisions where partial capacity is overstated. The question is whether those activities can be performed safely, reliably and for the proposed hours—not whether a task can be attempted once.
How NSW Work Injury Claim can help
For patella injury, a claim review can help to clarify diagnosis and mechanism of injury and compare work duties with medical restrictions. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
For patella injury, a claim review can help to respond to treatment or work capacity disputes and prepare WPI evidence when the condition becomes stable. The purpose is to identify the precise decision and the evidence needed for the next available step, not to promise an outcome.
Common questions about patella injury claims
How can work cause or aggravate patella injury?
For patella injury, the relevant work history may include twisting while loaded, kneeling or squatting, and falls on stairs or uneven ground. A claim still depends on the actual chronology and medical evidence. The records should identify what changed, when symptoms began or worsened, and how the diagnosed condition affects the worker's duties.
How is WPI assessed for patella injury?
For patella injury, NSW Guidelines Chapter 3 applies AMA5 Chapter 17 subject to NSW corrections. The most specific valid method is used, and where more than one valid method applies the highest valid evaluation is generally selected unless Table 17-2 permits a combination. The file should identify direct anterior trauma or documented patellar dislocation/translocation, fracture alignment, movement, instability and radiological cartilage loss. Pain or crepitus alone does not select a table row. The assessor must apply the NSW Guidelines to the accepted, stable condition; the diagnosis or an operation does not by itself determine a percentage.
Which records are most useful for a patella injury assessment?
A patella injury assessment commonly needs the accepted injury description, date and any insurer decision limiting the body part or diagnosis, imaging and operation reports, including the relevant side, level, compartment and procedure, repeat movement, stability, alignment, circumference, limb-length or neurological measurements required by the selected method, and a calculation worksheet identifying the table, regional unit, permitted combinations, conversion and rounding. Those records are most useful when they describe the same diagnosis, examination findings, treatment history and practical work restrictions.
What does an insurer commonly dispute about patella injury?
For patella injury, common issues include whether symptoms are due to arthritis only, whether surgery or replacement is work-related, and whether kneeling, stairs and standing duties are realistic. The response should address the insurer's stated reason with the relevant chronology, clinical findings, investigations and duties evidence rather than relying on the diagnosis alone.
How can patella injury affect weekly payments and suitable duties?
Capacity evidence for patella injury may need to address standing, walking, stairs, kneeling, squatting, driving and load carrying, safe duties that avoid unsafe mobility demands, and travel to work and medication effects where relevant. A certificate should describe what the worker can do safely and sustainably. Proposed duties should then be checked against those restrictions and the real demands of the job.
Does patella injury automatically receive a fixed WPI percentage?
No. For patella injury, one verified example is patello-femoral pain or crepitation: No standalone percentage quoted here; use only when the NSW footnote criteria are met, under NSW Guidelines para 3.24 correction to AMA5 Table 17-31. That value applies only when its stated criteria are met. Pain, tenderness, swelling or difficulty walking does not create a percentage without a valid lower-limb method.
Request a calm claim position review
If you have received an insurer decision or you are unsure how your injury evidence fits together, we can help you identify the issue, organise the documents and consider the next step. Where ILARS funding is approved, eligible legal costs and necessary disbursements may be covered.