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Author Topic: plica syndrome/hole in cartiledge  (Read 2336 times)

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Offline mom

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plica syndrome/hole in cartiledge
« on: February 17, 2005, 06:59:06 AM »
Hi!  I'm new to this.  I have a 14 year old daughter that just plica removal surgery on her left knee last July.  She also has it in her right knee.  She was a competative swimmer for 7 years, and the repetitive kicking aggravated the situation. My daughter was going to have surgery on her right knee this summer, but she still has pain in her left knee.  Her OS says that she has a "hole" in her cartiledge where the plica rubbed, and one of her options is to have her kneecap drilled into to form scar tissue (?).  I thought she just had scar tissue removed.  Please inform me which topics I should look into, and what experiences other people have had.  Especially any swimmers.  I'm hoping she isn't doomed to a life with Advil.  Thanks. :)

Offline Heather M.

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Re: plica syndrome/hole in cartiledge
« Reply #1 on: February 17, 2005, 08:02:51 AM »
I was a competitive swimmer until half-way through my junior year, when I was seriously injured in a car accident.  At age 13 I had my first flare of knee pain, and we became aware of the fact that I had poor knee mechanics and patellar mal-alignment, and that this was causing me to rub at and irritate the articular cartilage coating the back of my kneecap.  It sounds exactly like what your daughter has, only I didn't develop plica syndrome.  Unfortunately, plica syndrome is often an indicator of underlying issues like very bad knee mechanics.  The orthopedic surgeon I saw at age 13 said there were no good surgeries to correct poor knee mechanics and patello-femoral syndrome (PFS), but that with some modification of activities and special exercises, along with a knee brace, I was able to deal effectively with my condition for almost 18 years.  I will say that I gave up the competitive swimming, but that was more due to my car accident than my knee.  I did have to give up swimming the IM, because breast stroke is very stressful on the knee.  And so is freestyle, for some reason--backstroke is much more knee friendly, so I did that and butterfly.

Anyway, if your daughter already has cartilage damage to the extent that the doctor is talking about doing microfracture (the procedure he discussed, which is designed to produce scar cartilage, aka fibrocartilage.  This is very different from scar tissue!  Anyway, to have a cartilage defect big enought or deep enough to require restoration at her age is pretty serious.  I mean, this is what you expect to see in a middle aged adult.  To be honest, if I had known then what I know now, I would have backed off on the competitive sports and focused harder on physical therapy and patellar taping to help improve knee mechanics.  That's just my opinion, speaking as someone who had osteoarthritis at age 32.  And spending a lifetime on Celebrex (which I graduated to when Advil ceased to work well enough) is the least of my worries--daily debilitating pain is what I'm facing, with a huge impact on my work and social life.  It's something to take very seriously when you look at your fourteen year old daughter's future.  And while it is important to keep active and do non-impact things like swimming, the way most competitive swimmers work out is very hard on their joints. 

Anyway, the sections you want to look at are the patello-femoral joint and the rehab sections.  You really need to find a surgeon who deals with young athletes and early cartilage damage all the time.  To have cartilage restoration via microfracture at her age is very, very rare.  So rare that you must realize there is a reason for this....could it be that something else is causing your daughter's pain levels?  Some problem besides the cartilage damage?  Be aware that just because someone has cartilage damage does not mean that they have pain from it--in fact, lots of people have cartilage damage but no pain from it.  The plica could be the source of her pain instead--sometimes plica can grow back, or excessive scar tissue can develop in the area where it was removed.  Your daughter could have a serious, underlying mechanical problem such as severely mal-tracking kneecap which causes pain and has damaged the cartilage.  You have to look at what actually caused the damaged cartilage or the lesion that the doctor described--it didn't appear on its own!  Sometimes mal-tracking can lead to lesions in the articular cartilage, and it is the mal-tracking kneecap that causes pain, not the damaged cartilage it leaves behind. 

This type of knee problem is very, very complicated, and there is no easy surgical fix.  Let me repeat that, just for clarity:  there is no easy surgical fix for PFS.  If there were, this web page wouldn't exist, because we all would be cured ;) .  And it's important for you to understand that most people with PFS are able to lead normal lives--pain-free--with minimal activity and lifestyle modifications, along with specialized exercises.  Your daughter may need to give up certain strokes, reduce or eliminate some cross-training activities (like running stadiums, stairs, certain weight-machines such as extension units, certain floor exercises like lunges and squats, and follow rigorous and very BORING repetitive exercises in a PT setting), and commit to things like bracing and patellar taping...but the chances are excellent that she will lead a very normal life.  It's just that some decisions must be made now, in order to preserve her knee cartilage for later.  I wish I'd known at the time, but the issues facing young female athletes just weren't well-known or researched at the time I was in high school.

To be honest, many orthopedic surgeons still don't understand the issues facing female athletes in the formative stages of their growth and development.  So finding a great surgeon will go a long way toward setting your daughter up for success.  An excellent PT or certified athletic trainer with a background in swimming would also be a great addition to your daughter's medical team--perhaps her surgeon can recommend one?  Or you can look up physical therapy clinics that focus on sports performance enhancement--that kind of facility should have an ATC able to help.

You will also need to do a lot of research on patello-femoral syndrome or PFS.  If you get into the subject deeply enough, you may find that you know more about this condition than many doctors!!  Sad but true....if you want to post the general area where you live, someone here might be able to recommend a doctor who has worked a lot with this condition in the past.

Here are some links to get you started, once you've read up on the kneeguru's patella topics (go to the home page and follow links for patient information).  Great overview--follow all of the links related to anterior knee pain or the patella.  You might also want to consider Dr. Grelsamer's book, "What your doctor may not tell you about knee pain and surgery."

Info on PFS:  A great web page that will help explain what is potentially going on.

Info on chondral defects or small areas of damaged cartilage, as your daughter apparently had diagnosed during surgery:

Information on Microfracture, the cartilage restoration technique your daughter's doctor discussed:

Hope this information helps.  The patello-femoral section is the main one for people in your daughter's situation.  There is lots of reading there!

Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja