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What to expect after plica surgery - KNEEtalk spotlight #03

Spotlight on plica surgery
Spotlight on plica surgery
© KNEEguru

It is not uncommon for a knee surgery patient to learn what a plica is only after they have had one surgically removed! A plica is a fold of joint lining that may remain as an apparently useless anatomical remnant of the development of the knee during one's time as a foetus. It may never cause a problem, or it may become a troublesome problem - but one thing for sure is that it can mimic other conditions. Unless the surgeon is very aware of this the unsuspecting patient may go into the operating room for a 'meniscus' issue and emerge to find that they have instead had a 'plica' issue, and that the plica has now been resected (cut away). 

Many of the issues around rehab for plica surgery are raised in this bulletin board discussion -

Arrow   "Plica surgery- Slow recovery or cause for concern?"

 

The discussion focuses on what to expect during the recovery -

Spoltlights #03

    1. How long after plica resection does it take to get back knee strength to the level it was before surgery? How long can one expect to be off work?

    2. Why is the knee so uncomfortable for so long after a plica resection? Why the crackly noises or feelings?

    3. Are there any special requirements during rehab, such as using crutches?

    4. What is the association with joint cartilage damage such as chondromalacia? Is there an association with meniscus damage or the fat pad?

    5. Can a plica re-grow?

Let's look at these particular questions.

plica of the knee

1. How long after plica resection does it take to get back knee strength to the level it was before surgery? How long can one expect to be off work?

The question is not an easy one to follow because there are different types of plica and different degrees of abnormality if a plica is problematical. There is the  medial plica, the suprapatellar plica, the infrapatellar plica and rarely the lateral plica.

The one that is most commonly identified as causing problems such as pain, snapping, catching, pseudo-locking, and giving way is the medial plica. It can be quite big and thickened and resection can be quite extensive and the raw area can extend into the fat pad area and only the joint wall. It may also have become caught in the joint so often that the joint cartilage is softened and even fissured, and this can slow down the rehabilitation period.

Reference to the discussion reveals that rehab can take up to a year, but some people are fine after a few weeks. It would be helpful to ask the surgeon about the extent of the resection, whether any fat pad was excised, and how much cartilage damage was present.

The next most tricky plica is probably the suprapatellar. Many surgeons refuse to believe that these are ever the cause of symptoms, but I have watched so many surgical videos that have demonstrated the plica being nipped between the quads tendon and the femur that I do not believe this. I think that some of the rehab issues relate to this plica not being recognised as the cause of symptoms and not being resected, with a continuation of symptoms after the surgery.

2. Why is the knee so uncomfortable for so long after a plica resection? Why the crackly noises or feelings?

A plica resection can be quite a traumatic procedure. But the surgeon often deals with other issues at the same time, trimming softened bits of joint cartilage, possibly performing microfracture, trimming the fat pad which may be enlarged and contributing to the problems.

Also the removal of the plica may alter the tracking of the patella, and this may be a cause of discomfort if there is already damage to the joint surface there.

The crackly noises may be due to the cartilage changes, but may also possibly be due to adhesions in the area of resection. It is important to rehab well, and to include patellar mobilisation exercises in the regime.

3. Are there any special requirements during rehab, such as using crutches?

There is no need for non-weight-bearing unless a microfracture has been done. The important elements of rehab are to regain range of motion, and also to keep the patellar area free from adhesions with patellar mobilisations.

4. What is the association with joint cartilage damage? Is there an association with meniscus damage?

If a plica is catching in the joint, the chances are that eventually the white shiny joint cartilage will become stressed, soften and even fissure and fragment in the area of the catching.

In my opinion, the relationship between the plica and the meniscus is that the symptoms of a catching plica mimic very closely those of a catching flap of a torn meniscus. An experienced surgeon will know this, but a less experienced surgeon may be astonished when he/she goes into the knee and finds that the meniscus is absolutely normal!

5. Can a plica re-grow?

Just read the bulletin board discussion again. It is clear that 'yes' a plica can re-form. The scar tissue can form into a band-like structure similar to the original plica.

Also, remember that the medial plica might be removed but the symptoms may continue if they were in fact also related to an abnormal suprapatellar plica.

Keyword (tags): 
Updated: 17 Jan, 2014
ABOUT THE AUTHOR

Dr Sheila Strover

Clinical Editor
Degrees: 
BSc (Hons)
MB BCh
MBA

Dr Sheila Strover is the founder of the KNEEguru website. Although not a knee surgeon, she has a sound understanding of knee surgery and...

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