The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: daedalus on January 20, 2009, 07:40:37 PM

Title: Plica surgery
Post by: daedalus on January 20, 2009, 07:40:37 PM
I saw my OS again yesterday.  Here's a brief history of my problem - had motorcycle accident 2 1/2 years ago, fell on my right knee, had a deep laceration down to the surface of the patellar tendon.  No surgery yet.  Have had multiple MRI's and X-rays which have all been negative.

I have throbbing/aching pain when standing, walking, kneeling, driving, etc. 

I've been doing physical therapy 3x per week for the past month with no improvement yet.  The OS suggested to continue PT for one month, and if there's no change he will do a scope.  He said it's highly unlikely he will find anything wrong inside my knee, so in that case he will remove the plica and see if that helps the problem.

I asked if it's possible the MRI missed something which he will see from a scope.  He said that is possible, but extremely unlikely since modern MRI's are so accurate.  I asked if there are any complications from plica removal, and he said that's highly unlikely as the plica is not necessary for the knee to function.  Are these statements accurate?  Or is there a chance of making my knee worse by removing the plica?  How successful are plica removals?

Also, I'm not sure if my symptoms are consistent with plica syndrome.  I have pain on the medial side of my knee, but there is no cracking or catching when bending at a normal angle.  There is cracking however when I do deep squats, like a crepitous sound.

I'm nearing the end of the rope.  I'm expecting PT won't do much, so I will probably get the scope in a month or so.  But if the plica removal doesn't work, I've exhausted my options.  I'm just not sure if my problem is related to the plica, and it doesn't sound like the OS knows either.  Any help or advice is greatly appreciated.

Title: Re: Plica surgery
Post by: aparks2001 on January 27, 2009, 03:36:04 PM
First, if you have a chronically inflamed plica, the chances that PT at this point will do anything for it are quite small.  In fact, PT can make it hurt worse.  Second, most orthos are very ignorant about plica problems simply because there is so much controversy and relatively little data regarding plica problems.  Plicas can be the sole initiator of pain due to one insult that causes the initial inflammation, or they can be irritated by a host of other problems including mal-tracking.  If the mal-tracking is not addressed, the plica can come back even after it is removed because you are treating the symptoms, not the cause. 
As for your surgery, if a plica is the problem, the chances of making it worse with a scope are considered to be small, however it absolutely possible.  Once the plica is removed, the area heals back with some degree of scar tissue, and this can make the band worse than before.  This is what happened in my case (I am a competitive cyclist), and I am going to have to go back and have another scope to remove the scar tissue.  But for me the inflammation was likely initiated while learning to snowboard.  it was obvious from the MRI and my symptoms that the plica was the problem in the first place.  Sounds like it is less certain for you. 
Having said that, no knee surgery is minor.  I had a simple scope on both knees to remove one plica in each.  I am already very active and was able to get back to the gym and riding by 3 weeks.  However, it has been about 4 months post op and my knees still get pissed off and swollen when standing for extended periods or even elliptical for 30 minutes.  Forget running, and cycling is out of the question due to the scar tissue band snapping at every stroke.  The swelling is getting better every day and it is clear that it will eventually not be an issue, however even at my activity level I can see it taking a year to get back to 100%.
Title: Re: Plica surgery
Post by: daedalus on January 28, 2009, 03:30:44 AM
Thanks for your reply.  I'm really at a loss about what to do.  I've stopped the PT as it had no benefit whatsoever, despite the therapist assuring me I would be 100% cured.  I don't think he has any idea what is causing the pain, and the exercises aren't helping at all.

I guess I should just bite the bullet and get the surgery.  But I'm really not convinced plica removal will help me at all, and I'd be taking the risk of making my knee worse.