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Author Topic: **HELP** Plica Syndrome Surgery  (Read 4841 times)

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Offline TheEbae

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**HELP** Plica Syndrome Surgery
« on: February 01, 2015, 01:35:09 AM »
Hello all,

I was swimming (I am a competitive swimmer) breaststroke 2.5 months ago when I felt a snap and a pop in my left knee. This was then followed by pain and mild swelling. We went to our orthopedic urgent care clinic where I was diagnosed with an MCL sprain. I was put in a hinged brace for 1 week and told to follow up with one of the practice's sports medicine doctors if I had not improved by the 2 week mark. Sure enough, I did not improve and we went to see a sports medicine doc. Since I have had clicking and some popping in my knee, he scheduled an MRI to rule out a torn meniscus. My MRI showed some fluid and he thought he saw a plica, but no torn meniscus. He then prescribed 6 weeks of PT and said that the next steps would be 1) cortisone injection and 2) scoping the knee to remove the plica. The pain is evidently right where my doc expects the plica to be and is very tender to touch. PT also suspects some popliteus involvement, but I understand that there is not much they could do for that. At the 6 week appointment with functional improvement but still a lot of pain, he offered to give me the cortisone injection but said it wouldn't actually heal my problem. To me, that wasn't worth it. I want my problem fixed, not the pain masked. So, he said we could try 4 more weeks of PT but didn't know if it would work. He said if I didn't see any improvement by the 3 week mark to call back in for an appointment to come up with a game plan. I almost think my pain is worse than it was at that appointment and my 3 week mark is Wednesday... I am a young athlete who is itching to get back to her sport. I am so sick of this pain and want to be DONE. We saw my chiropractor the other day who confirmed the plica diagnosis and said that he thought I would have to get the scope. Being someone who uses their knees so much, he felt like that would be the best option. We have known him for years and really trust him. He is very anti-surgery, so when he said surgery we knew it would likely be the only option.

My mom is worried about the success rate of the surgery. She is nervous about the possibility of me getting worse after surgery. Honestly, I am so done that I am ready to pull the trigger and go under the knife. We would really appreciate opinions. I had a major shoulder injury 2 years ago, so this brings back many bad memories. I think it is worth the risk since we have 3 people agreeing that plica is the problem.

Summary of symptoms since this was so long  ;)
-Medial knee mottling (worse with activity)
-Knee swelling (also worse with activity)
-Tender to touch along plica and popliteus
-Pain along plica (feels like a sharp knife) that is lesser at rest and worse with activity
-Clicking when extending and occasionally bending knee
-Some popping and crackling in knee
-Difficulty with stairs
-Some pain with walking

Thank you so very much for any help!!!

EBae
~The EBae~

11-12-14 MCL sprain
12-08-14 Plica Syndrome diagnosis
2-24-15 Plica and scar tissue removal surgery
4-20-15 Patellar Tendonitis onset

Offline Clarkey

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Re: **HELP** Plica Syndrome Surgery
« Reply #1 on: February 01, 2015, 12:08:44 PM »
Hi EBae,

Welcome to KG, I am sorry to read that you are going through knee problems with your plica; I can only give you my own personal experiences with how I dealt with my right knee problems that is still ongoing that as not yet been resolved.

My knee problems started after a slip on the pavement while jogging in October 2007, prior to that I have always had knee pain on and off since childhood. I felt sharp pain and catching on the lateral side of my right kneecap and did the normal routine of PT 1st that did not help and then had an MRI scan. It showed fluid around the fat pad region that I can see came up in your own MRI scan fluid in the knee.

I think that if you have fluid inside the knee it is highlighting that the knee has got something wrong inside the kneecap and the fluid is a natural protection that occurs if the knee is not happy. It always helps if you have an understanding and well trusted OS that you already know well and glad he not the type of OS that likes to get out the scalpel straight that many OSís seem to be doing.

I also had some swelling at the bottom of my kneecap which is has never really gone down due to having been through two scopes that can cause permanent swelling around the portals. I also had a cortisone injection into my fat pad that only numbed the pain that you also have found out.

Having your plica removed can go either way as with any knee surgery it can be a great success or it can be a failure.  It's is a risk and gamble to go for the scope as soft tissue injuries are hard to get right again.

You may find that having your plica removed will be a great success and can return to sporting activities pain free or with minimal pain and discomfort as long as you follow advice from your OS and PT post op and do the PT exercises you been told to do.

The only reason why my 2 scopes so far have been a failure is that I am more prone to scarring and had to have anterior interval release surgery during my 2nd scope. Not everyone that has knee surgery gets excessive scarring afterwards, I was unlucky was one of the unlucky ones.

Scope #1 fat pad trimming and medial plica excision, my medial plica problem did not show up in my MRI scan that was spotted when my OS was inside my right knee with his camera. The surgery did stop the catching sensation I was feeling pre-op.

Itís good and normal to be cautious about having to have surgery done, you should listen to the knee expert your OS who sounds level headed who knows that surgery is the only option left and should listen to his advice.

Good luck with what you decide to do next, I hope that my own personal experiences has come in useful.

[email protected]
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 TheEbae

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Re: **HELP** Plica Syndrome Surgery
« Reply #2 on: February 01, 2015, 03:07:46 PM »
Clarkey,

Thank you so much for the reply! I have found it very helpful and interesting. I had 2 rounds of injections in my shoulders and neck (one round had to be done at a surgery center and involved many different injections), all of which did nothing for me. I am so hesitant to do an injection if it is just going to prolong my injury and we will end up with the scope anyway.

If I have 3 trusted people agreeing on a diagnosis, would you say that it is an accurate diagnosis? I understand that the only way to know for sure that it is in fact my plica causing the pain is to go in and look. My mom is just very worried about the possibility of getting worse after surgery. I am as well, but I also think it may be worth the risk. I feel kind of stuck. This clicking, popping, and cracking I am having is miserable.

At this point, I am entering my 8th week of therapy and have seen no improvement in 3 weeks. No pain improvement from day 1, but functional improvement. My mom still says that I walk with a limp. It is much better, but I am not walking normally. This problem is interfering with my daily life and I really wish it would stop. If I haven't gotten any better in so long, is it likely that I will improve to 100% function with the 2 weeks of prescribed PT I have left? Along with the pain,  This clicking, popping, and cracking I am having is miserable.

I would be curious to see if they found anything else wrong inside of my knee once they scoped it.

I will call the OS to schedule an appointment on Wednesday if I am not considerably better. I am trying to decide if I would allow the injection or ask to go straight for the scope. My thought (and  my chiropractor's) was that if my plica is still in there and has been known to cause problems before, what will keep it from becoming painful again once the numbing from cortisone wears off? I am so active that I would likely inflame it again within a week. I swim (swam, I guess  :-[ ) 6 days a week for 1.5 or 2 hours at a time, CrossFit once, and dryland/cardio/weight training 2x per week. Overall, I probably spent 2.5 or 3 hours each day in training.

Thanks again for your help!
EBae
~The EBae~

11-12-14 MCL sprain
12-08-14 Plica Syndrome diagnosis
2-24-15 Plica and scar tissue removal surgery
4-20-15 Patellar Tendonitis onset

Offline Clarkey

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Re: **HELP** Plica Syndrome Surgery
« Reply #3 on: February 02, 2015, 05:10:18 PM »
Hi EBae,

I fully agree with you that cortisone injections will only numb the pain and discomfort and does not solve it! I can tell you this from my own experience after having two cortisone injections pre-op and post when I had exploratory scope #1 it did not really help both injections.

It also not a good to have too many cortisone injections into the knee as it will weaken the knee structure increasing the chances of cartilage degeneration! Once your cartilage starts to go it cannot be reversed and the kneecap will gradually wear away.

The only way at times for an OS to take a good look whatís going on inside your knee is to do an exploratory scope. My OS did pre warn me he may find nothing wrong inside my right knee and would be taking a risk to go ahead with the surgery. Thankfully he found problems inside my kneecap that were soft tissue injuries.

Soft tissue injuries to the knee can be extremely painful and crippling and often after an MRI scan it will show up nothing majorly wrong inside the knee when in fact there is a problem. Soft tissue injuries often are not picked up on an MRI!

I also fully trust my OS who will always do surgery as the last option, he also told me if my knee is causing me problems with my daily activities and in pain and disconfort then it worth allowing him to take a look inside my right kneecap.

I am not a great fan of cortisone injections as there is a danger and risk that you could end up making your knee problems worse as you cannot feel as much pain while doing something physically active.

This is why so many professional sports men and women end up retiring with a chronic knee problem as they are given too many cortisone shots that's not good for the knee in the long run.

Good luck with your OS appointment on Wednesday.

[email protected]
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 TheEbae

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Re: **HELP** Plica Syndrome Surgery
« Reply #4 on: February 03, 2015, 05:39:54 PM »
Hi Clarkey,

Once again, thanks for the reply. I had PT this morning. He decided to do all stretches today since I am inflamed and have not improved with other methods of therapy. He also applied some kinesio tape, which in the past has given me some pain relief. I am aware that for the plica, this will only be for pain relief and not actually fixing the problem. I am so thankful for my PT, as he has not given up on me and completely understands my frustrations. I am so frustrated because I am 14... I should not be having knee problems like this (my doctor said this is a problem typically seen in older patients) and should not be having problems healing.

I am fairly certain that I will push to avoid injections. In my mind, surgery is not that much more invasive than injections, considering the risks. I personally do not like the idea of masking the symptom when you have the possibility of making things worse while it is numb. I am very against painkillers (now, there are obviously times that they are needed, but I do not like them for the average injury) because I believe that pain is our body's way of telling us that there is something wrong. That is not to say that I haven't popped a Tylenol here or there in an attempt to lessen the pain, but I try not to use them too often ::) (By the way, it did nothing for the pain  :'( )

If I am not mistaken, the plica is a band of soft tissue, so I think that it may be worth the risk... Maybe. I am pretty miserable. I had to babysit the other night and even that was very hard for me. I can't do much without feeling that I am fighting my knee. I try to not let it control me, so I go out and do things that I later regret. I am even struggling with the decision of whether or not to go to a youth group movie night with our church, as this is at a movie theater and I do not do well sitting in one position for long.... *sigh*, the fun of knee injuries!

It sounds like the risk of making the knee problem worse with surgery is the same (or less) than doing the injection! Yikes. I really would push for the scope. My OS is very good about us making the decisions. When I asked for  4 more weeks of PT instead of injections, he said, "That's fine, it's your choice!" And then I knew he was a good doctor. I think the only reason he may say no to a scope right away would be if insurance needed me to try and injection before resorting to a scope.

Chiropractor tomorrow. We will decide the next step (if I should call the OS or not, and if so, what to say) then since we trust him the most of all my doctors.

I am not ready to retire from my sport. At all. That's why my chiro thought surgery would be inevitable. Our State swim meet is in 4 weeks and I am not sure if I will be able to swim in it. It isn't looking that way, but I believe that God is more than able to heal me in time if His will is for me to swim in the meet. If not, I need to be content in the place which He currently has me, as I know it serves a purpose in His plan. Just not fun to have to sit out while your best friends get to make memories and have fun together, you know? :-\ But God is GOOD, regardless of my circumstances!

Thanks again for all of the help! I will keep this page updated with what we decide to do and how it goes.  ;)

EBae
~The EBae~

11-12-14 MCL sprain
12-08-14 Plica Syndrome diagnosis
2-24-15 Plica and scar tissue removal surgery
4-20-15 Patellar Tendonitis onset

Offline Clarkey

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Re: **HELP** Plica Syndrome Surgery
« Reply #5 on: February 04, 2015, 05:44:14 PM »
Hi EBae,

I am sorry to see that you are already having knee problems at such a young age and will get there in the end as you have a bonus that you are young still and developing. I do know that many young females in particular are more prone to experiencing knee problems at a relatively young age.

I think maltracking and patella femoral syndrome (PFS) can be a common knee condition amongst adolescent females in particular. I am not saying you already have these conditions or will develop them just something that can occur and easily fixable with a good PT that you already have got.

Having any type of knee surgery is a risk and as your OS is conservative and would only take a look inside your knee as the last option I would listen to his expert knowledge and guidance as he knows best.

I assume if you did go ahead with an exploratory scope it your 1st experience of having a general anaesthetic that can be daunting and a frightening experience if itís your 1st experience that did really stress me out when I had scope #1.

Thankfully the theatre team were excellent as they made me feel at ease before going under and that was not as bad as I thought it was going to be.

I am sure whatever you decide to do you will be able to carry on being physically active again and only a small setback for you to endure. Most knee surgeries are a big success and only tend to get members on KG with continuing ongoing knee problems.

It is good you are in an active your local youth group, I use to help at my local catholic church youth group with teenagers around your age early teens 13 to 15. I helped doing the church ground gardens right up until my knee scope #2 and told the priest will be having knee surgery the day before my scope. I now had to tell the priests I cannot do the gardening anymore.

He gave me a blessing and the anointing of the sick that I did not expect and I did find it was helpful as I was really cool, calm and relaxed walking into the preparation area outside the theatre. I was not at all nervous right up until the point the GA was administrated into the cannula at the top of my hand. I then fell into a nice deep sleep, before I knew it I woke up in recovery and was taken back to the day unit ward.

Maybe other members can also give you some advice and guidance of what to do next, good luck with what you decide to when you next see your OS.

[email protected]
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 TheEbae

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Re: **HELP** Plica Syndrome Surgery
« Reply #6 on: February 06, 2015, 03:58:00 PM »
Hi Clarkey,

Yes, I have heard that PFS is common with plica syndrome, but my doctors and therapists have not mentioned it, so I am hoping that I do not have that problem.

We saw my chiropractor on Wednesday. He said that he thinks it'll be surgery. We decided to go to a doctor in Indianapolis (we live in Indiana) because we don't trust our smaller-town OS here too much. This guy is supposed to be one of the best operative sports medicine docs in Indiana, so we are looking forward to seeing him. Hopefully he will pull the trigger on whatever will work! :) Our appointment is Wednesday, so prayers for a clear treatment path are appreciated!!!

Yes, it would be my first surgery. I am hoping to stay awake for it with either a local anesthetic or an epidural. I don't want to watch the surgery on the monitor, I just want the surgeon to be able to talk to me while he's fixing my knee  ::)

I completely agree that it is important to be active in your church. My faith and relationship with Jesus Christ is everything to me. Nothing else matters. He is my everything!

By the way, I have tried to do the plica snap test on myself (even though it's super painful because I am really tender in there!), and I feel a snapping, ribbon-like structure in there when perform the test. Would this be the plica? This "band" structure is much smaller and harder to get at in the good knee. I have to dig to find it whereas I can very easily feel it on the bad knee.

Thanks again!
EBae
« Last Edit: February 08, 2015, 12:44:04 AM by TheEbae »
~The EBae~

11-12-14 MCL sprain
12-08-14 Plica Syndrome diagnosis
2-24-15 Plica and scar tissue removal surgery
4-20-15 Patellar Tendonitis onset

Offline Clarkey

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Re: **HELP** Plica Syndrome Surgery
« Reply #7 on: February 07, 2015, 04:44:36 PM »
Hi EBae,

I am pleased for you that you are going to be seeing one of the top OSís in Indianapolis, it always good if you live close to a well respected and contentious OS that has a good reputation is always an added bonus.

I am also lucky that I live in the UKís 2nd largest City of Birmingham so have a good choice of the UKís top knee specialist surgeons. I have had knee problem now for over 12 years and have finally found an OS I fully trust and respect.

My OS has a nice personality as he good with his patient that makes a big difference if you can get on ok with someone that is going to do all they can to rectify your knee problem.

1st surgery is always going to be the most anxious of all as you do not know what to expect as you may feel ok about the surgery if you did end up needing to have a exploratory scope. The morning of the surgery when you step into the hospital and get dressed into a theatre gown is when I find the nerves start to kick in.

Here in the UK it usually the patient preference if they rather be fully awake and fully asleep during the surgery. An epidural would be done if you rather be awake during the surgery. During the surgery the theatre staff should provide headphones so you so can listen to the songs you like and may even be able to watch a DVD of your choice. 

Some OSís will request that the patient is fully sedated under GA, I am sure this will not happen to you if you do have a scope with your OS respecting your wishes that you rather not be sedated.

Please do not attempt to do the plica snap test if it causing you a lot of pain and discomfort as you could do further damage to the knee. The intense pain is due to the knee not being happy. I ignored the pain I was getting after both scopes pushing myself too hard too soon that caused my right knee to flare up even more.

I know that not all KG members put their faith and trust in God so will not think or believe that the power of prayer will make a difference! I have been baptised and brought up as a practicing Catholic.

The priest always has a few minutes of refection and praying during Sunday Mass to remember anyone that you know needs to be prayed for, I will include you that your appointment turns out a success and knee problem will be fixed and can return back to sporting activities pain free.

Good luck with you OS appointment on Wednesday.

[email protected]
« Last Edit: February 07, 2015, 05:14:11 PM by Clarkey »
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