Banner - Hide this banner





Author Topic: London Surgeon Recommendation for Lateral Plica Resection  (Read 3769 times)

0 Members and 1 Guest are viewing this topic.

Offline remi2000

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
London Surgeon Recommendation for Lateral Plica Resection
« on: April 18, 2011, 04:55:29 PM »
Hi all,

I just came across this site. I would love to get your advice.

I have had a problem with my right knee for almost 10 years now, (I am 32 years old) starting with pain around the outside (lateral) and top edge of the patella after running. Eventually it started clicking/snapping on the top right (lateral) side of the patella, as though a band were being snapped across the bone - every time I take a step or bend the knee. I seriously overpronate, and also have "duck feet" ie. my feet point out to the sides when my knees are pointing straight.

I have tried orthotics, physiotherapy, have strengthened my quads and tried stretching my hamstrings, with no signs of improvement. My physiotherapist said I have a tight Illiotibial band, and it could be that causing the pain and the clicking/snapping - so I tried a bit of work with the foam roller and also stretching (pigeon pose in yoga), but again that didn't help (interestingly, the foam roller, though slightly painful, actually hurts more on my left leg. Also, a personal trainer who tried it with me said that usually his clients are screaming in agony when the foam roller is used, whereas I just had slight discomfort).

I haven't run in around 8 years, but made up by getting into cycling, which didn't cause me pain. I had X-rays and MRI done, neither of which showed up anything.

Around a year ago I saw a surgeon in London who said I may have a plica, but the only way to tell for sure is by doing an arthroscopy. Since I was still able to cycle pain-free, I left it at that - no point in having surgery.

Recently however, I have started getting pain after cycling as little as 10-15kms. And the clicking/snapping is still there - which can't be good in the long term! I am getting really frustrated as now I'm running out of exercise options - and I really love cycling.

I have three questions:

1) given my history, what are the chances that it could still be ITB syndrome, and I just haven't tackled it properly?
2) is it worth trying the arthroscopy & is plica resection generally simple/easy to recover from?
3) who is the best surgeon in London to go to for plica resection? (note it has to be London as I live in Africa and am planning to visit London soon)

Thanks in advance for all your help,

Remi


 


Offline knee always hurts

  • Forum Faithful
  • ****
  • Posts: 233
  • Liked: 0
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #1 on: April 18, 2011, 07:34:08 PM »
Hey,

I also have the sensation that a band or bands of tissue are snapping across my right knee in the same location as you described. I would be interested if you get surgery and find out that it was indeed a lateral plica. From everything I have read, it sounds as if this might be the case for me but I have not gotten a diagnosis from any doctor. I have actually put it on the back burner to some extent as a result of my other knee being far worse.

I don't know why you were diagnosed with ITB syndrome, as it doesn't sound like you have pain on the outside of your knee. What you have is definitely a problem with the patella and not the IT band. Where the IT band comes into play is that it is sometimes regarded as exerting a force on the patella causing it to track too far laterally. While this may or may not be the case for you, there can be other reasons for the maltracking, as well. The reality with patella problems is that sometimes even if you correct the reason for the initial problem, the pain doesn't stop because the forces underneath the patella are so great that the tissue can never recover properly.

If you are certain that it is a plica, it might be worth trying a cortisone shot first. In about 50% of cases, this will solve the problem. Although, given that you have had this problem for 10 years, it might be less likely to resolve it. Still, it is probably worth a shot before going the surgical route. If you do opt for surgery, there is no certainty. For some people, the pain issue is resolved completely, and there are no further issues. On the other end of the spectrum, I have seen people on this forum get a plica resection surgery and they are in more pain than before the surgery. Surgery is never a sure thing. The surgery is arthroscopic so complications are minimized. As best as I understand it, you will be able to bear weight immediately after surgery, but you'll probably want to restrict your activities for a few weeks so as to allow your knee the best chance to recover.

Good luck to you!

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4971
  • Liked: 424
  • Neelie knee!
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #2 on: April 18, 2011, 07:50:25 PM »
There are a number of very good knee surgeons in London - check out the information hub for each surgeon details.  I have 2 very good OS, neither are far from London, about an hour for each, one North, one South

I don't think plica resection is really a specialty in itself, I am sure most knee surgeons will have experience? 
Have a look in the dedicated section for feedback from those who have had it done - it doesn't seem that straightforward to recover from for many
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline knee always hurts

  • Forum Faithful
  • ****
  • Posts: 233
  • Liked: 0
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #3 on: April 18, 2011, 07:55:23 PM »
Yeah, I don't think it is a particular specialty. A well trained arthroscopic doctor should know what to look for. If anything, make sure they are familiar with the patella and that they don't just do work on the meniscus, for example.

From what I understand, though, symptomatic lateral plicas are unusual. Most surgeons are going to be more familiar with medial plicas. Still, it should be something that they have learned and you will find it in many surgery textbooks.

Offline kscope09

  • SuperKNEEgeek
  • *****
  • Posts: 691
  • Liked: 0
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #4 on: April 19, 2011, 11:02:14 AM »
Some people find plica removal very difficult to recover from and often need another scope as sometimes they either grow back or are replaced with scar tissue.  I had lateral plica and had stabbing pains that acme on very suddenly and get soem occaisional pain but nothing too bad.  My pt said he thought there was soemscar tissue and did a deep friction massage to break it up, I had that about 3 times and it really helped.  From what I've seen on this forum, I as one of the lucky ones.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline CamillaLuise

  • MINIgeek (20-50 posts)
  • **
  • Posts: 33
  • Liked: 0
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #5 on: April 19, 2011, 11:42:54 AM »
The Wellington Hospital is very good and some of the orthopeadic surgeons there are used by my private physio.



TTT and lateral release 15th April 2011 in London, UCLH
LR was not done when he was in there as he wanted me walking quicker rather than non weight bearing with an LR. He proposed he might do it later if there was still a lot of scar tissue.

Offline Stasha83

  • Forum Faithful
  • ****
  • Posts: 226
  • Liked: 0
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #6 on: April 19, 2011, 11:47:34 AM »
The knee unit at The Wellington hospital has some brilliant surgeons. My surgeon also works there and he has been amazing, his name is Mr Rahul Patel. I honestly can't recommend him enough. Good luck!

http://www.rahulpatel.net/
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline CamillaLuise

  • MINIgeek (20-50 posts)
  • **
  • Posts: 33
  • Liked: 0
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #7 on: April 19, 2011, 12:30:16 PM »
Rahul Patel operated on me on Friday. Brilliant, brilliant surgeon.
TTT and lateral release 15th April 2011 in London, UCLH
LR was not done when he was in there as he wanted me walking quicker rather than non weight bearing with an LR. He proposed he might do it later if there was still a lot of scar tissue.

Offline Clarkey

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 4190
  • Liked: 77
  • Neil TheElephant knee packed up carrying his trunk
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #8 on: April 19, 2011, 05:50:58 PM »
Hi Remi,

I suppose I could say I am a victim of medial plica excision as my knee was better off pre op then it is post op. I now feel pain and discomfort when squatting and trying to run around the portal on the medial side. Also had my fat pad trimmed that was catching on the lateral side that has now gone post op.

Soft tissue problems and injuries are hard to get right again and many people seem to have long term problems. Rahul Patel looks like an excellent OS to see and another excellent OS you could see for a consulation is Mr Andy Williams.

http://www.drfosterhealth.co.uk/consultant-guide/Mr-Andrew-Michael-Williams-3199503.aspx

Good luck with you consultation and treatment.

Nick :) {2011} :)
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Chainsaw_gran

  • MICROgeek (<20 posts)
  • *
  • Posts: 15
  • Liked: 0
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #9 on: April 19, 2011, 06:25:30 PM »
Hi   Your symptoms and physio "diagnosis" sounds soooo like mine, This was me, 18 months ago!!! I finally had a Tracking Scan which is very specialised and only done by surgeons specialising in Patella problems. I had to give up running because the pain afterwards was so bad. I concentrated on hard cycling which was fine at first but the pain eventually became as bad as that following running especially after very steep or long hills. The knee clicking I discovered was my knee-cap dislocating as it jumped out of the groove in the femur below. Try getting a second opinion, available to everyone on the NHS but check the surgeon is a Patella specialist; not all knee surgeons are. I live SE London. Hope you you get this sorted. I have just had surgery. It will be slow recovery but so far positive. 
March 2011. Elmslie trillat/TTT. Autologous Collogen Induced Chondrogenesis to patella n Trochlear.

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4971
  • Liked: 424
  • Neelie knee!
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #10 on: April 19, 2011, 06:38:32 PM »
One thing to consider given you are not UK based - is the op being self funded or covered by health insurance that covers the UK?  Not all insurance companies cover all surgeons (I know mine doesn't) nor of course all procedures (again, mine doesn't  >:( ), so once you have identified some possible docs, check :)

Good luck :)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline remi2000

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #11 on: April 30, 2011, 09:43:16 AM »
Hi all,

Thanks so much for your replies. Some food for thought there.
I came across a surgeon, Fares Haddad at the Wellington Knee Unit.
Anyone used him before? Any thoughts?

I have insurance that covers the UK so no worries on that front.

Thanks

Remi


Offline remi2000

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #12 on: April 30, 2011, 09:45:37 AM »
Also - Chainsaw Gran - which surgeon did you use? Can you please tell me a little more about Tracking scans?

Regards

Remi


Offline Stasha83

  • Forum Faithful
  • ****
  • Posts: 226
  • Liked: 0
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #13 on: April 30, 2011, 02:05:23 PM »
Prof Fares Haddad is considered one of the best knee surgeons in the country. He trained my surgeon, Rahul Patel. I had my last surgery at The Wellington and you would be in very good hands there.
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline Clarkey

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 4190
  • Liked: 77
  • Neil TheElephant knee packed up carrying his trunk
Re: London Surgeon Recommendation for Lateral Plica Resection
« Reply #14 on: April 30, 2011, 02:32:27 PM »
Hi Again,

I agree with the others and would be best to go to 'The Wellington Knee Unit' for treatment of your knee and have a link of the OS's that work there who all look like excellent knee surgeons and can pick one most that is most suitable for your knee condition and problems.

http://www.thewellingtonkneeunit.com/team.asp

Nick :) {2011} :)
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming