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 instead had a 'plica' issue, and that the plica has now been resected (cut away). It is not uncommon for a knee surgery patient to learn what a plica is only after they have had one surgically removed!

 

How long after plica resection does it take to get back knee strength to the level it was before surgery?

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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.

medial plica being nipped between knee bonesThe 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 cause irritation there. The fold of plica tissue 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.

Rehab after surgery 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.

 

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

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Plica surgery can in itself be quite a significant 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.

 

What is the association of a plica with joint cartilage damage? Is there an association with meniscus damage?

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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!

 

Can a plica re-grow?

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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.

 

Many of these issues around rehab for plica surgery were raised in this bulletin board discussion -

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


See also:


eBook about synovial plica

An overview of plica problems in the knee - ebook


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