Nick’s Medial Plica Excision & Fat Pad One Year Post Op

One year after having had surgery on my right knee on Monday 16th November 2009 and have seen no vast improvements so far apart from no catching anymore on the lateral side of the knee. I still cannot squat without feeling pain on at the bottom of the knee and when I try to fully squat feel more intense pain at the back of the knee and feel tightness and discomfort. Also sometimes get pain above the knee.


My private physio I am seeing told me to try running on the treadmill at the gym which I have done but knee swells up more after using the treadmill. I told him that knee swells after being on the treadmill so has told me to no longer use the treadmill and to go swimming instead. I found that the knee does not swell up so much if I set the treadmill to 4.6kmp/4mph rather then going 5mph or above which seems to put more impact on the knee, running at a slower pace put less impact on the knee.


I finally managed to see Mr Green rather then his Registrar on Tuesday 27th July 2010 and he could not physically find a problem with my right knee. The ultrasound report said there was some thickening around the medial ligament, and Mr Green was not too concerned about it. I told him I can no longer run or squat or kneel without feeling pain at bottom of knee and pain behind the knee when I fully squat. During the physical examination of my right knee he could not locate the pain but he did not apply any pressure to my knee as he did pre op which pin pointed where the pain is.


Mr Green decided that I may benefit going to the Pain Management Clinic and they may give me some medication to reduce the pain. Mr Green referred me to Dr Kumar who will access my right knee and decide how best to sort out the knee pain. I may have to have a blood test and maybe another injection and will not know what is going to happen next until Tuesday November 30th 2010 when I see Dr Kumar at the Pain Clinic.


I saw my private physio after Mr Green’s consultation and told him I feeling pain in both knees and found that I was getting pain around the patella tendon. My physio suggested seeing a Podiatrist to observe my Biomechanics by watching the way I stand and walk. I would benefit wearing costume made orthotics rather then wearing the NHS orthotics that are not as good as the privately made ones in America. It would cost a lot of money but would be worth saving up for as it could ease pain in both knees. My physio also suggested buying a good pair of running trainers once the costume made orthotics have been made.


I saw the Podiatrist in Solihull, Birmingham who asked me to wear a pair of shorts for the appointment to observe clearly my Biomechanics and spotted that I was slightly flat footed and would benefit from raised arches. The Podiatrist also spotted I had maltracking in both knees. I told him I also feel pain in my hips and said orthotics would help stop or ease the pain and put less strain on the joints. He looked at my Biomechanics by getting me to walk on the treadmill and by the way I stand. The Podiatrist came to the conclusion that I would benefit wearing costume made orthotics that would be made in America that works out cheaper then having them made in the UK.


I was told to bring a few pairs of shoes and spotted some wear on one side of my work boots that’s shows that my foot aches are not raised enough and leaning to one side. I showed him the NHS orthotics and told me the material they use is too soft and not firm enough. The ones made in Detroit in America are done with good quality material and be one mould rather then pieces stuck together like the NHS orthotics. The cost of having the full Biomechanical and Casting would be £325 this would include appointments before and after having the orthotics made. I cannot afford it at the moment so would have to save up to have them made and might be something worth investing as it going to benefit me by putting less strain on my joints.


The reason for having surgery in the 1st place was to be able to run again which I unable to do since October 2007 after falling onto pavement while jogging. One year after the surgery and knee feels worse now then it did pre op with more pain at the bottom of the knee. The only improvement is that there is no longer any catching on the lateral side of the knee which was caused by an inflamed fat pad that was trimmed during surgery. I could kneel and squat without feeling too much pain pre op but now feel more pain and discomfort. I am now at the same stage as I was pre op as I can walk as a reasonable pace and can kneel upright without feeling too much pain but cannot squat or run which I hoped to be able to do 1 year post op.


Having the medial plica surgically removed seems to cause most patients problems as the majority of KG Members that have had medial plica excision have had nothing but problems post op and do not fully recover from the surgery. Medial plica excision can cause a build up of scar tissue that may need to be removed through surgery if conservative methods fail such as friction massage and cortisone injections. My physio told me my surgical scars should hardly be noticeable but can clearly still see the incision area particular on the medial side of the knee so I am more prone to scar tissue build up.


No matter how much physio I do the knee does not seem to be improving and have followed what my physio told me to do and go swimming once a week and the gym 3 times a week. The only improvements I have seen since my quads have become stronger is that my knee no longer gives way as it did for a few months after my surgery and can do more exercises at the gym. I can now use the treadmill for 20 minutes at a speed of 4mph/6.4kmp that I find is a comfortable speed without putting too much strain on the right knee. I did try to run at 5mph/8kmp but found it made me right knee swell up more and feel pain inside the knee if I try to run too fast.


The swelling is mainly around the bottom of my right knee by the portal areas and most likely to be scar tissue causing me all the problems. If I try to start running without the aid of the treadmill I feel pain at the bottom of the kneecap so cannot even begin to run again without the help of an OS. There is clearly still a problem with the right knee and maybe if the scar tissue was removed during a 2nd scope then I may be able to run again or may end up with an even worse knee as scar tissue removal has no guarantee that it’s going to solve the knee problems.


I could well have Arthrofibrosis which can often happen after medial plica excision as its fairly invasive surgery which can create a large build up of scar tissue. The key areas that Arthrofibrosis may affect are the region behind the patellar tendon below the kneecap, around the top of the knee where the quads meet the kneecap and behind the knee. I often feel pain in these 3 areas so could well have Arthrofibrosis.


I have an appointment at the Pain Management Clinic on Tuesday 30th November 2010 to see Dr Kumar to access my right knee and to decide what the best option would be to get me back running again and with less pain. I have not had a blood test or an x-ray for over 7 years so he may decide to do a blood test and x-ray to see if I have rheumatoid arthritis or wear and tear in the knee joint as well as checking how aligned my knee is.


It is coming up to 3 years since I started going to the BirminghamRoyalOrthopaedicHospital also known as the WoodlandsHospital and they been good most of the time and is world class OrthopaedicHospital. They should be able to work out what’s wrong with my right knee that’s never been the same since my fall back in October 2007. I am seeing Mr Green one of the UK’s top OS’s who I fully trust, who has not yet discharged me and sure he will do all he can to get my knee right again which can take longer to get sorted because it’s through the NHS. If I saw him at his private clinic my knee would have been sorted out by now. The NHS has improved over the last few years with less waiting time for surgery.


My main goal now is to be able to run again and not have pain when squatting and kneeling. I know my right knee will never be 100% again but would be nice to be able to be more physically active again and be able to take part in mini marathons and who knows may one day be able to compete in a full marathon.

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