Advertisement - Hide this advert





Author Topic: Medial Plica Syndrome - Cyclist  (Read 3892 times)

0 Members and 1 Guest are viewing this topic.

Offline HankZ70

  • MICROgeek (<20 posts)
  • *
  • Posts: 2
  • Liked: 1
Medial Plica Syndrome - Cyclist
« on: April 02, 2015, 06:15:07 PM »
I'm reasonably certain I have medial plica syndrome in my left knee.  The first time it came up was in 2012.  I'm primarily a cyclist, but had been running more due to work travel.  I went to OS with knee inflammation.  X-rays normal.  MRI normal (though now looking at the MRI, plica is visible - of course very few plicas are symptomatic).  Did PT with no improvement.  OS injected cortisone into knee from lateral side.  No improvement.  Got back to running and riding a few months later, but still with some discomfort and swelling - basically a near constant sensation of joint effusion and pain primarily near the medial joint line along medial side of patella, but patella itself not painful.  Pain while cycling eventually resovled and in winter/spring 2014 knee felt great.  I was lifting, including squats and leg press.  Did a mountain bike relay race.  Banged my kneecap on a log, but rode more laps without any pain at all.  Two days later I went for a ride. No knee pain up to that point.  About a mile into the ride, the area above my patella - really felt more like my lower quad started with a burning sensation.  Rode a few more times with similar pain.  Ran on it a few times because that was less painful than riding.  Visited physiatrist who did ultrasound and diagnosed "quadriceps tendonopathy."  Reduced riding, stopped running, oral anti-inflammatory.  No improvement.  Constant feeling of joint effusion in anterior medial portion of knee.  Palpable band popping over medial femur with every single pedal stroke. Tried topical NSAID - Voltaren.  Very limited improvement.  Stopped riding for a month, though was hiking on a regular basis.  Upon return from month long trip, physiatrist did ultrasound again.  Said tiny amount of inflammation remained and advised to ride more and see if knee flared up so he could find a spot to inject.  Started riding again and pain "magically" resolved.  Pain free from August 2014 until Feb. 4, 2015, including an 80 mile ride in mid-November 2014. Even running occasionally with no discomfort at all.  Did a long ride on Feb. 4, 2015.  Rode the next day and had a tight/swollen sensation in lower quad just above patella.  Eased back on riding a lot, but within a week got to the point where 10 minutes or so of easy spinning on bike caused the painful, burning sensation along top of knee, especially on the medial section just below along the end of my VMO muscle.  When stretching hamstring, I had a painful tightness/pulling sensation in the lower quad/top of knee.  After a couple of more weeks of trying to find limited, low impact cardio activity, e.g., walking on treadmill, swimming, it seems that anything that requires me to bend my knee repeatedly, impact or not, exacerbates the inflammation.  I saw another physiatrist that my wife was seeing for back problems.  Sent him an article on diagnosing plica syndrome with ultrasound.  He confirmed plica syndrome.  Went to an OS last week so that I'd have an OS involved in any decisions going forward.  He was extremely dismissive of the idea of plica syndrome.  Ordered new MRI which we'll compare with 2012 MRI.  Seemed to focus on chondromalacia and wants to do viscosupplement injections.  I've been doing therapy excercises since the pain came on - hamstring stretching VMO strengthening, ice massage, foam rolling and more. I have good hamstring flexibility and well-developed quads, including VMO in affected leg.

A few questions:
1.  Has anyone with plica syndrome had similar experience of early stages involving tightness/swollen feeling in lower quad area above knee?  It looks like that are is an insertion point for the medial and suprapatellar plicae based on anatomy textbook drawings.
2.  Has anyone had plica pain appear and disappear quickly?  Has anyone had a similar experience where it turned out to be a piece of something, cartilage, plica, or something else floating in the knee and getting stuck in the wrong place?
3.  Has anyone had success with viscosupplements for plica syndrome?

Thanks.

Offline Clarkey

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 4183
  • Liked: 75
  • Neil TheElephant knee packed up carrying his trunk
Re: Medial Plica Syndrome - Cyclist
« Reply #1 on: April 02, 2015, 07:06:58 PM »
Hi HankZ70,

I have been through a similar scenario to with the symptoms that you are currently describing, I did try all the conservative methods 1st before going for the last option of an exploratory arthroscopy in November 2009 on my right knee.

My symptoms pre-op was sharp pain and catching at the bottom of my right knee on the lateral side. I went through PT, cortisone injection, ultra sound therapy and an MRI scan, the scan came back normal apart from fluid and inflammation around the fat pad. 

In the end I opted to go for surgery and once my OS was able top take a good look inside my kneecap he saw that my medial plica was inflamed and enlarged. My medial plica was completely removed as well as trimming of my fat pad that was also inflamed hence the catching and sharp pain I was experiencing.

I was a long distance runner at a competitive level and found the 1st scope caused me to form excessive amounts of scarring inside the knee and ended up needing a 2nd scope in July 2014 to remove the scar tissue. The scarring was causing me a lot of pain and discomfort! I was not able to run and still cannot to this very day and worse off now then I was pre-op to scope #1 & #2 so should always take the surgical option as the last resort.

Cycling is not such a high impact and strain on the knees as running is, swimming is also good way to exercise without making a not so happy knee even more unhappier! I been told glucosamine chondroitin that's a natural supplyment should be taken by the 1st OS I saw back in 2003, others say it does not really have any benefits.

I have to stop now as it is the start of the Easter break, I hope the information I have given so far is useful, any further questions I will do my best to answer in due course.

[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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 46
  • Liked: 6
  • 2 Corinthians 12:9-10
Re: Medial Plica Syndrome - Cyclist
« Reply #2 on: April 08, 2015, 04:14:59 PM »
Hey HankZ70,

I had my plica excision about 6 weeks ago. I had very similar symptoms to you. Upon arthroscopy, it was in fact my plica that was causing the problem. I also had quite a bit of scar tissue build-up around the plica.

Honestly, I would give conservative methods about 6-8 weeks and then go for the scope. The rehab wasn't fun, but it didn't last long and I am now released from PT. I was allowed to swim at 4 weeks post-op (I am a competitive swimmer, which is why they wouldn't release me sooner) and now am doing various exercise classes. I am now able to enjoy spin classes, Pilates, piloxing, PiYo, and TRX classes. I have my life back!

My surgeon said that he likes to give plica syndrome 6 weeks with conservative methods, but if that fails, he goes to a scope. It was so, so, so worth it for me.

I had success for awhile with turmeric and d-ribose supplements, but it ended up becoming too inflamed (and it built up scar tissue) for the supplements to do any good. I highly recommend them for post-op, though, and I think that is part of the reason that my recovery was so fast.

In case you want to compare your symptoms to mine, here's the list of symptoms I experienced:
Skin mottling (not classic for plica syndrome, but something that was evident with mine)
Clicking/popping sensation when walking, bending, straightening, swimming, biking, etc
Sharp, stabbing pain with movement
Dull and achy pain at rest
Minimal swelling
A pinching sensation (only once the scar tissue was formed) after sitting for too long

Good luck with everything! Keep us updated :)

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 Lofty76

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 0
Re: Medial Plica Syndrome - Cyclist
« Reply #3 on: April 27, 2015, 09:25:36 AM »
Ebae, good to hear your success story as I am 3 weeks post plica removal myself.

What Rehab did you do to be so active after 6 weeks?.
The phyio exercises that I was given are very very basic.

Offline TheEbae

  • MINIgeek (20-50 posts)
  • **
  • Posts: 46
  • Liked: 6
  • 2 Corinthians 12:9-10
Re: Medial Plica Syndrome - Cyclist
« Reply #4 on: April 28, 2015, 06:59:32 PM »
Lofty76,

I worked my butt off in therapy! That's all I can say :) I progressed very quickly and surprised my therapists. We started with the basic heel slides, leg raises, hip abductions, etc. My home program really didn't change much. I was RELIGIOUS with my exercises.

I got off the crutches 1 week early (so, 2 weeks post-op) and that really helped me. I also started squatting (mini-squats to start at week 3 and was at a deep squat by week 6) fairly early. I think that helped me. I stayed in fairly good shape throughout the injury, which was helpful.

One thing that didn't go as planned in my rehab was getting my quad strength back in a timely manner. I build muscle very easily, but I really struggled to get that quad back. Even today, as normal as I feel, my operative leg is not as strong as my non-operative. Don't become discouraged! You will get it back. I was shocked because I always build muscle so easily as an athlete... This was completely different.

Overall, rehab went beautifully and I am so grateful for my outcome! My advice to you would be 1.) Normal gait is key!!! 2.) Work at those squats! They help so much, even if they hurt at the time. 3.) Don't get caught up in the quad strength! Everyone heals at their own pace.

Good luck! Keep us posted :)

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 Lofty76

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 0
Re: Medial Plica Syndrome - Cyclist
« Reply #5 on: April 30, 2015, 08:10:45 PM »
Cheers Ebae.
Interestingly how did you about re-building the quad? That's something I have been advised to do.

Offline Lanterne Rouge

  • Regular Poster
  • ***
  • Posts: 133
  • Liked: 0
Re: Medial Plica Syndrome - Cyclist
« Reply #6 on: May 01, 2015, 09:23:46 PM »
Hey Hank,

I was also a keen cyclist like you but had to give up on it one and half year ago because of the very similar symptoms you mentioned. I was having no trouble while riding but after 6 to 12 hours I was having inflammation around the area above the kneecap. It was getting really sensitive and tender and I was feeling like my bones were crushed on the lateral side when I had too much inflammation.

Do you have a sharp pain when you pressed down on the top edge of your patella? I mean the area 1 inch above the patella? I had this symptom during the examinations on few occasions of my doctor visits. Maybe 8 out of 10 doctors that diagnosed me said it is patellafemoral syndrome or chondromalacia. One of them suspected quadriceps tendinopathy and latest doctor I visited said I have early form of arthritis. I still don't know what it is. I have also loud poppings and catching/snapping of patella when I straighten my knees from bent position. I was having non stop inflammation for weeks and months at some point but now it is much better. I think walking has helped me to get rid of this chronic inflammation. I was riding my bike to work around 7-8 km a day with almost no pace but it was still upsetting my knees. I stopped riding completely now and walking around 4-5 km almost every day. In the beginning I had soreness on my hips after the walks. I think it was a sign of very weakened gluteus medius. I recommend you to check if you have any weakness on your hip muscles. I was thinking cycling was working out those muscles but it seems it doesn't. Maybe I was doing something wrong or I hadn't have a proper bike fit. I don't have much hope left to be on the bike again but I hope to have helped you a little here.

Offline HankZ70

  • MICROgeek (<20 posts)
  • *
  • Posts: 2
  • Liked: 1
Re: Medial Plica Syndrome - Cyclist
« Reply #7 on: May 14, 2015, 06:52:13 PM »
Lanterne Rouge,
Thanks for your post.
I don't have any of the patella symptoms you describe.  My pain is limited to the soft tissue area between my patella and the end of my femur.  I get a slight bit of a pop when under my patella when I extend my leg but it's not painful and I have it in both knees.

The OS has done everything he can to discourage me from having surgery, including essentially threatening that if he goes in for the plica syndrome he's going to graft cartilage onto my kneecap and possible even do a lateral release (I wouldn't agree to that of course).  I'm getting a viscosupplement injection (Gel-One) in a couple of weeks.  OS says he was not a believer at first, but the positive results in his patients have pushed him to it.  I'm skeptical, but there appears to be no downside.

I've basically decided that doctors aren't going to help me.  I found a PT on my own, but I've mostly been self-treating.  You're right about the glutes.  I've been working on my glutes and general posterior chain a lot.  The single thing that has helped me the most is doing the "sofa stretch."  I saw at least a 50% improvement in my symptoms after doing this stretch for just a couple of days. 

https://www.youtube.com/watch?v=-ZX1QMTdAC4

Check out Starrett's other mobility videos.  Lots of great stuff.

I've also been doing lots of stretching (especially quads and hip flexors) and hip mobilization and squats and deadlifts.  Have your foam rolled your quads?  If you feel painful spots you probably need to work on those trigger points and loosen them up).  I've gotten back on the bike and can ride without pain though the knee doesn't feel quite right yet.  Still have a slight feeling of edema in the joint.  I hope some of this helps you.  Good luck.

Offline dal_knee

  • Forum Faithful
  • ****
  • Posts: 367
  • Liked: 47
Re: Medial Plica Syndrome - Cyclist
« Reply #8 on: May 14, 2015, 07:40:34 PM »
Hank,

If a stretching program is helping you, you may find dry needling an excellent adjunct treatment.    PTs or chiropractors use this treatment.     

On another note, I find it disheartening that the surgeon "threatens" to perform surgeries with poor outcomes on you?     For what reason.   
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline Lanterne Rouge

  • Regular Poster
  • ***
  • Posts: 133
  • Liked: 0
Re: Medial Plica Syndrome - Cyclist
« Reply #9 on: May 15, 2015, 08:46:57 AM »
Hank,

If this stretch helps you, does it mean you have a tight TFL? Were you sitting a lot? When I was cycling I was barely getting on my feet. I was sitting either in the office chair or on the bike saddle. Changing my habits didn't help me much though. I was able to get rid of continous inflammation throughout the day but I still have that soft tissue pain around few inches above my patella. I think I am generating edema around this area continously. I have loud pops when I don't have much edema but when it gets inflamed too much my kneecap snaps silently in and out of position. I can feel the maltracking especially on the first few steps.

« Last Edit: May 15, 2015, 08:56:50 AM by Lanterne Rouge, Reason: deleted my question about ehler danlos syndrome. I think it doesn\'t relate. »















support