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Author Topic: Plica Removal Post-op  (Read 90 times)

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Offline nw1942

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Plica Removal Post-op
« on: November 25, 2019, 12:05:26 AM »
Hi All,

23 y/o male


Following a 5 hour hike in July 2018 I developed persistent right knee pain and swelling over the medial anterior portion of the knee. Although, I probably didn't give it the best rest & recover regime. This has happened before, but it seemed to subside over the following days. I have dislocated this knee when I was 10.

I initially when through a round of PT with a dx of patellar tendonitis, this was over a course of 8 months. However, this didn't improve my symptoms. taping the patelly upwards to unload the anterior compartments seemed to give some releif prior to surgery. MRI showed small medial plica, normal medicus, tendons ligiments etc.
Following a steroid injection that didn't not improve my symptoms, I underwent an arthroscopy in July 2019 which found a small fibrotic medial plica, and some mild cartilage abrasion. I was told the plica was removed and cartilage cleaned up during surgery. Post-op I struggled to get the swelling down, but the pain had subsided significantly (I am guessing swelling stop whatever was rubbing from... rubbing!).

8 weeks after surgery I was pain-free and able to walk my dog for 30 minutes after work each day. I went on a 1.5-hour hike through the bush (moderate use of stairs), which followed with delayed swelling and pain 1-2 days after.

Since then I have never really been able to recover, the swelling appears to go down with extended extension and overnight during sleep, and will puff up and is very sore with flexion and repetitive flexion activities. Tender over medial femoral condyle to palpate when flexed.

Swelling is and always exclusive to the anterior medial compartment/over and below the medial femoral condyle.

I am currently unable to do any forms of exercise that involve and sort of knee flexion. I also have an office job (engineer), and to limit pain I sit with my legs straight and it is painful to get up and and down from my chair and use stairs, car rides/ driving can become sore too if flexed. I am currently unsure what to do. My ortho isn't interested and says there's not much he can do, suggesting another possible steriod injection.

My theories as to what is causing my reoccurrence disability;
-possible the entire plica was excised, or regrown?
-Bone spur?
-Synovitis?

I am grateful for any advice - I am at the end of my rope - although I'm only 23, total knee replacement doesn't seem that crazy to give symptom relief (I think I would struggle to convince an ortho to do).

Cheers in advance.

Photos of plica/knee attached below.
« Last Edit: November 25, 2019, 04:26:06 AM by nw1942 »

Offline The KNEEguru

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Re: Plica Removal Post-op
« Reply #1 on: November 25, 2019, 10:16:14 AM »
I had a medial plica removed when I was about 40. Prior to the surgery I was having a lot of crepitus (crunching) particularly going down stairs, and occasional catching and a lot of general knee discomfort. I had no limitation of movement. After the surgery I was astonished at the amount of pain, swelling and limitation of flexion. Getting in and out the bath was a torment. But the crepitus had completely gone, I must say. The knee always played up after that if I went for long walks, and flexion remained limited for years. Then gradually flexion returned and the knee was no different from the other one.

My retrospective assessment was that there was some arthrofibrosis in the area. I was neglectful of physiotherapy and knew nothing of patellar mobilisations.

I suspect your situation might be similar but you are still in the relatively early post op phase and maybe should work on patellar mobilisations  (https://www.kneeguru.co.uk/KNEEnotes/ebooks/how-perform-patellar-mobilisations) and gentle range of motion exercises without pushing the knee into inflammatory situations, maybe using ice before and after exercise. Steroid injections are known to cause damage if over-used. Sitting with the leg straight may help you get your work done, but I imagine you should still break from work intermittently and take the knee through flexion a few times an hour.
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Offline nw1942

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Re: Plica Removal Post-op
« Reply #2 on: November 27, 2019, 06:35:25 AM »
Hey Mate,

Thanks for the reply.

Yeah, I haven't touched into scar tissue release/patella mobilisations that much. A PT did recently probe around that area when flexed 90 degrees and found it was very tender along the end of the medial femoral condyle, and it swelled up in the hours following.

I find that the more my knee swells, the less pain I get when trying to walk around. It's a bit of a conundrum, I find I can function better with some swelling (I know this is not god for my knee long term), but using NSAIDS reduces the swelling but seems to increase the pain.

Will discuss this with PT at next follow up, although I don't know if patellar mobilisation will help if the pain is closer to the medial femoral condyle.

How was your swelling post-op and did you find the patellar mobilisations?

Thanks for the advice















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