The SPECIALIST'S OFFICE => The patello-femoral joint => Topic started by: jaymes on July 05, 2019, 12:43:18 PM

Title: can plicas cause bone marrow oedema to appear on MRIs?
Post by: jaymes on July 05, 2019, 12:43:18 PM
My mri shows bone marrow edema inferiorally in the medial femoral condyle &  lower pole of patella, that looks like the same region as a medial plica could it be the plica that's causing the edema to be here? The plica is fibrotic.  If so would removing the plica also make the bone marrow edema go away?

I've read here "Bone marrow oedema is not directly related to plicasyndrome; however, it can be observed in cases of internalderangement or impingement. "Https://

does that mean if a plica is impinged, it can be one of the causes that bone marrow edema appears in an mri?
Title: Re: can plicas cause bone marrow oedema to appear on MRIs?
Post by: The KNEEguru on August 28, 2019, 11:39:50 AM
An impinging plica can cause fraying or even splitting of the joint cartilage of the femur or patella, and if that is the situation then it is reasonable to assume that the bone might become contused underneath the damaged bit.
Title: Re: can plicas cause bone marrow oedema to appear on MRIs?
Post by: Clarkey on August 30, 2019, 12:08:26 PM
Hi Jaymes,

Sorry that you are having problems with an impinging plica, hopefully it will settle down without the need for surgery. My right knee saga started with medial pain and catching. Scope #1 had medial plica excision fat pad trimming. Took over 18 months to recover from the surgery. Got back into long distance running until I slipped on black ice directly onto my right knee. Scope #2 looked similar to your ongoing knee problem that is quoted on my MRI scan report 2014 post-op diary.

My 2014 MRI Scan Feedback on my right knee:

  Diagnoses: Anterior knee pain right knee previous Botox injection facia lata.

This gentleman returns to clinic. He has not really had significant relief following Botox injections and IT band stretching and as such we went onto perform and MRI scan of the knee. This has shown medial femoral condyle bone oedema which I think probably represents cartilage degeneration.

He also has an abnormal signal within the fat pad but this is probably representative of his previous arthroscopy and scarring because he did suffer with stiffness.

It is always difficult to know exactly why people develop medial facet or medial trochlea disease as usually it is the lateral compartment of the patellofermoral joint which suffers from maltraking.

He does have a low TT-TG distance which may explain this and he is slightly varus. His IT band is still tender today but exquisitely painful and his popliteal angles were very good.

I think the only step forward I could go would be to undertake an arthroscopy to assess the medial trochlea, potentially there is scar tissue or band which is rubbing on this area which could explain the oedema but similarly it could well be a control lesion.

If it is small we could treat this at the same time with a microfracture but if it is larger we may need to return to use a different technique. He is fully aware of this.

Nicholas states that his pain is now impinging on his daily life and would like to consider intervention. I have listed him for a knee arthroscopy and will see him in due course.

There not much else I can do; I will leave it in the expert hands of Mr Snow that I have 100% confidence.

Mr Snow is there to help me that I fully appreciate, I will try best to remain positive Pre Op; it is just unfortunate that I have maltracking, bowed legged and a low lying patella that has started to wear the knee out, I may have to think wisely is it sensible to do run distance running in the future post op?

Mr Snow suggested cycling instead of running; I can see his point of view as it is the closest you can get to running with minimal impact on the knees.

It just hard to get use to the idea at the age of 35 that I may never run competitively again long distance that was something I was rather good at.

I can only blame myself as I ignored the knee pain while running and also ran at a too quick pace and now I am paying the consequences for my actions. 9 miles in just under an hour I have proof of, that is of some credit.

Also have an even better reason to help and support children with special needs instead of manual labour jobs like gardening and greenkeeping. It will just make my knees worse; doing a complete career change is a wise move and my dream job.

Bad things happen in life for a reason!

[email protected]

Turned out not to be excessive scarring rather than bone edema and had anterior interval release surgery. Aggressive physiotherapy 6 weeks post-op aggravated the knee, developing excessive scar tissue. January 2018 had my 3rd scope, ended up with three procedures. AIR, distal patella excision and lateral meniscus repair. Wore a knee brace for 7 weeks partial weight bearing and can walk better but still cannot run.

Good luck.

[email protected]