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Author Topic: Plica removal surgery - scar tissue problems  (Read 246 times)

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Offline gmj1892

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Plica removal surgery - scar tissue problems
« on: September 08, 2021, 11:56:58 AM »
Hi all,

Would love to hear from anyone who's had a similar experience to me. Was referred to an OS after an injury to my knee earlier this year. At first a meniscus tear was suspected, but a knee arthroscopy revealed plica syndrome. The surgeon removed the plica and this solved my pre-op infrapatellar pain.

I'm six weeks on from surgery now. Ever since the operation, I've had medial knee pain just above the medial incision where the arthroscopy was performed. This is a sharp pain which is produced upon certain movements of the knee. Once it's been aggravated, the pain tends to linger for a while.

I went to see my OS again today. He is pleased with the progress I have achieved from physio - my quads are getting stronger, and he explained that no swelling, no generalised pain and full range of motion indicates no damage to the cartilage or other structures of the knee.

He believes my medial pain, which is at the site where the plica once was, is the result of impingement caused my scar tissue. He said to wait another 6 weeks and it will hopefully have improved. If not, he might use an injection which he says would help to break up the tissue. From my own prior research I know that cortisone shots are often used for pain relief without solving the underlying problem, but he says this injection would hopefully break up the tissue and thus, if successful, stop the pain.

Has anyone had a similar experience? It's very frustrating as this issue wasn't present before surgery, and while the initial problem has been fixed, I've ended up with a different one. There's also been no improvement at all in terms of the new medial pain since I first noticed it, which makes me sceptical that it will suddenly resolve itself in the next 6 weeks.

Anyone had a successful outcome for a similar issue?

Offline GeorgieR

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Re: Plica removal surgery - scar tissue problems
« Reply #1 on: September 27, 2021, 05:50:19 AM »
Hey @gmj1892,

This sounds similar to my situation.
I had a plica removed (as well as a bit of other work done) on 22nd of July, so coming up 10 weeks.
I had swelling up to around week 8 – which was limiting my range of motion. Only in the last week I have got full extension and flexion is still around 90 degrees, so still got a lot of work to do here.
I also have a sharp medial pain in the same area that you described that I didn’t had previously – in addition to this I have a constant pulsating feeling in the front of the knee, occasional sharp pain behind the knee and a burning/hot sensation over the knee cap most evenings. This is has all started since surgery.
I told the OS about all this at the 8 week telehealth follow up appointment – he is hoping it is all just ‘healing pain’ and wanted me to give it another 4 weeks, if its no better (12 weeks post surgery) he will look at further treatment. I haven’t had any real improvement in the last 2 weeks.

Its very frustrating to not get the results, have been seen physio and doing exercises daily. Surgery was my last resort after 8 months of living on pain killers, still having to take pain killers (for the new pain) is quite annoying.
Interested to see how you are getting on… :)

Offline Limping_Loafer

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Re: Plica removal surgery - scar tissue problems
« Reply #2 on: October 08, 2021, 12:48:07 PM »
Have you been encouraged to massage the area where the portal scars are? The sort of deep massage that can break up scar tissue? I had this and a steroid injection if placed correctly can really help. The impingement left me with palpitations on the affected side of the knee and constant low-level pain. Does that sound similar to what you've got? Everyone's different in how their body responds to a surgical procedure and it turns out my body responds by creating a lot of scar tissue. Sounds like your surgeon is on top of this and an injection will help to break up the scar tissue and you'll be on your way to a full recovery. Best of luck with it.

Offline gmj1892

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Re: Plica removal surgery - scar tissue problems
« Reply #3 on: October 12, 2021, 10:38:03 AM »
Hey @gmj1892,

This sounds similar to my situation.
I had a plica removed (as well as a bit of other work done) on 22nd of July, so coming up 10 weeks.
I had swelling up to around week 8 – which was limiting my range of motion. Only in the last week I have got full extension and flexion is still around 90 degrees, so still got a lot of work to do here.
I also have a sharp medial pain in the same area that you described that I didn’t had previously – in addition to this I have a constant pulsating feeling in the front of the knee, occasional sharp pain behind the knee and a burning/hot sensation over the knee cap most evenings. This is has all started since surgery.
I told the OS about all this at the 8 week telehealth follow up appointment – he is hoping it is all just ‘healing pain’ and wanted me to give it another 4 weeks, if its no better (12 weeks post surgery) he will look at further treatment. I haven’t had any real improvement in the last 2 weeks.

Its very frustrating to not get the results, have been seen physio and doing exercises daily. Surgery was my last resort after 8 months of living on pain killers, still having to take pain killers (for the new pain) is quite annoying.
Interested to see how you are getting on… :)

Hi Georgie. Sorry to hear about your problems. I can certainly empathise with your frustration at surgery providing you with more issues - that's not what we went under the knife for!

Good to hear you've made progress with flexion and extension. Hopefully once they're back to normal other things will start to improve for you. Unfortunately, and somewhat curiously, my medial knee pain has persisted even after regaining full flexion/extension and strengthening surrounding muscles back to pre-op levels. My physio seems a bit nonplussed by why I'm having so many ongoing problems despite being very quick with the rehab, and my knee being in good structural condition.

Like you, my OS advised me to wait until around the three-month mark before further treatment. Perhaps the injection will be mentioned as a possibility for you too? My knee is sadly in the same state as before so I'm waiting about 3 more weeks before seeing my OS again.

Keep me updated with your recovery, and best of luck.

Offline gmj1892

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Re: Plica removal surgery - scar tissue problems
« Reply #4 on: October 12, 2021, 10:42:40 AM »
Have you been encouraged to massage the area where the portal scars are? The sort of deep massage that can break up scar tissue? I had this and a steroid injection if placed correctly can really help. The impingement left me with palpitations on the affected side of the knee and constant low-level pain. Does that sound similar to what you've got? Everyone's different in how their body responds to a surgical procedure and it turns out my body responds by creating a lot of scar tissue. Sounds like your surgeon is on top of this and an injection will help to break up the scar tissue and you'll be on your way to a full recovery. Best of luck with it.

Hey there, many thanks for your message. I have indeed been encouraged to massage these areas. Doing so only seems to aggravate my knee, though, and while I understand this is common there's never any improvement a few days later. Perhaps I'm doing it wrong, or maybe the scar tissue is too thick or deep to be broken up this way - I'm not really sure.

Yeah constant low-level pain sounds pretty similar to mine, with regular flare-ups. I thought I was making progress after being able to go for two runs without any problems, but my latest attempt to do so led to me stopping after five minutes because it was too painful.

How did the injection work for you? Are you still having problems or did you overcome them?

Offline Limping_Loafer

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Re: Plica removal surgery - scar tissue problems
« Reply #5 on: October 16, 2021, 03:14:11 PM »
I'm a bit further down the line to you, but when I was where you are I would have loved to have been seeing my current OS. The people I was seeing when I was where you're at had no real clue about fat pat impingement, so they ended up causing further damage to my knee which was completely avoidable. Might be that your OS has brought you as far as he's able to. You could let him administer a steroid injection, but its placement is critical. If he puts it in the knee joint then it will be pointless and won't help. It needs to go into the fat pad and where the portal scar tissue has built up. If it's put in the right place, then you'll feel a difference within a couple of weeks. To be honest, I last ran before my first arthroscopy in 2011 and haven't been able to run due to my left knee since then. I do other things now to remain fit and active. After a poorly placed steroid injection didn't help (how could it?) my team got a bit creative and put my knee through various things which served only to damage it further over the years. Pair that with numerous physios who said they understood fat pad impingement when they didn't, and all these people go on with their busy lives while ours remain blighted. Well, after many years I found Charles Willis Owen who practices in Bournemouth, and he really helped get me back on my feet and be pain free for the first time in years in 2018. I was in a bad way when I first met him, on crutches and limping and generally struggling. I made him read my 10-page knee history and when he came to get me for my appointment he informed me that it sounded like textbook fat pad impingement straight away. He's had this condition himself and is an elite athlete and all-round good bloke. Fast forward a couple of years and a few silly things happened. I walked into a coffee table and hit the knee right on the fat pad (my proprioception is quite poor on that side due to all the issues over the years). Another steroid injection got me back on my feet again. An accident where my knee hit my car's steering column presented further issues and again, he got me back on my feet and out of pain within a few short weeks. Then I started working with a trainer and kept mentioning how fragile my knee was. I sounded like a broken record, but the knee was coping with all the exercises I was asked to perform. On our fifth session I was asked to do some low jump squats and I knew it was risky but as the knee was doing so well, I gave it a go. Very bad decision. This was in June and my knee deteriorated over 3 days and I haven't been able to walk since then. Charles gave me two large injections to try and help me with it (he only wanted to give me one, I had to persuade him to give me the second one as he felt it wouldn't help and he was right). This left us no option but to proceed to surgery. I had to wait 3 months for this as the steroid injections lower the immune system and increase the risk of infection. I had a bilateral fat pad trim and suprapatellar plica removal last Wednesday and was doing really well until a couple of days ago when I had my first physio session. He got me to do some deadlifts and raised leg bridges and calf raises and also wiggled the kneecap around a bit to check (I assume) there were no adhesions and it was free to move. I have no idea which one of those things unleashed holy hell but by 11pm on Wednesday evening I was in 10/10 pain which lasted until 1pm the next day (no sleep). GP and pain specialist (who I see every 6 months for facet joint injections due to facet joint arthropathy caused by gait changes due to the knee pain over time) came up with a plan and I'm now taking high doses of morphine 4 times daily along with paracetamol, naproxen and pregabalin, just to get me through this flare. I will no longer listen to anyone, regardless of their qualifications, when it comes to my knee. I know what’s best for my knee. My surgeon hand-picked this physio, as his patients have had good results with him in the past, but that doesn’t make him an expert on my knee. I hope you can benefit from my experience and avoid my pitfalls. If you get the injections now, then just be careful with the knee going forward. Once you’ve had fat pad impingement, you are susceptible to it again so need to do everything in your power to ensure you don’t place the knee in a position where it is likely to become impinged again. Best of luck to you and hope you can soon run pain-free again.

Offline gmj1892

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Re: Plica removal surgery - scar tissue problems
« Reply #6 on: October 17, 2021, 01:14:23 PM »
I'm a bit further down the line to you, but when I was where you are I would have loved to have been seeing my current OS. The people I was seeing when I was where you're at had no real clue about fat pat impingement, so they ended up causing further damage to my knee which was completely avoidable. Might be that your OS has brought you as far as he's able to. You could let him administer a steroid injection, but its placement is critical. If he puts it in the knee joint then it will be pointless and won't help. It needs to go into the fat pad and where the portal scar tissue has built up. If it's put in the right place, then you'll feel a difference within a couple of weeks. To be honest, I last ran before my first arthroscopy in 2011 and haven't been able to run due to my left knee since then. I do other things now to remain fit and active. After a poorly placed steroid injection didn't help (how could it?) my team got a bit creative and put my knee through various things which served only to damage it further over the years. Pair that with numerous physios who said they understood fat pad impingement when they didn't, and all these people go on with their busy lives while ours remain blighted. Well, after many years I found Charles Willis Owen who practices in Bournemouth, and he really helped get me back on my feet and be pain free for the first time in years in 2018. I was in a bad way when I first met him, on crutches and limping and generally struggling. I made him read my 10-page knee history and when he came to get me for my appointment he informed me that it sounded like textbook fat pad impingement straight away. He's had this condition himself and is an elite athlete and all-round good bloke. Fast forward a couple of years and a few silly things happened. I walked into a coffee table and hit the knee right on the fat pad (my proprioception is quite poor on that side due to all the issues over the years). Another steroid injection got me back on my feet again. An accident where my knee hit my car's steering column presented further issues and again, he got me back on my feet and out of pain within a few short weeks. Then I started working with a trainer and kept mentioning how fragile my knee was. I sounded like a broken record, but the knee was coping with all the exercises I was asked to perform. On our fifth session I was asked to do some low jump squats and I knew it was risky but as the knee was doing so well, I gave it a go. Very bad decision. This was in June and my knee deteriorated over 3 days and I haven't been able to walk since then. Charles gave me two large injections to try and help me with it (he only wanted to give me one, I had to persuade him to give me the second one as he felt it wouldn't help and he was right). This left us no option but to proceed to surgery. I had to wait 3 months for this as the steroid injections lower the immune system and increase the risk of infection. I had a bilateral fat pad trim and suprapatellar plica removal last Wednesday and was doing really well until a couple of days ago when I had my first physio session. He got me to do some deadlifts and raised leg bridges and calf raises and also wiggled the kneecap around a bit to check (I assume) there were no adhesions and it was free to move. I have no idea which one of those things unleashed holy hell but by 11pm on Wednesday evening I was in 10/10 pain which lasted until 1pm the next day (no sleep). GP and pain specialist (who I see every 6 months for facet joint injections due to facet joint arthropathy caused by gait changes due to the knee pain over time) came up with a plan and I'm now taking high doses of morphine 4 times daily along with paracetamol, naproxen and pregabalin, just to get me through this flare. I will no longer listen to anyone, regardless of their qualifications, when it comes to my knee. I know what’s best for my knee. My surgeon hand-picked this physio, as his patients have had good results with him in the past, but that doesn’t make him an expert on my knee. I hope you can benefit from my experience and avoid my pitfalls. If you get the injections now, then just be careful with the knee going forward. Once you’ve had fat pad impingement, you are susceptible to it again so need to do everything in your power to ensure you don’t place the knee in a position where it is likely to become impinged again. Best of luck to you and hope you can soon run pain-free again.

So sorry to hear about your ongoing struggles - sounds like you've had a lot of bad fortune down the years. Hopefully your current flare doesn't last much longer as that level of pain must be difficult to deal with. Really wish you the best of luck with that.

How would you describe the main symptoms of fat pad impingement in your case? My OS did use the word 'impingement' but didn't specifically mention the fat pad. I've read about it online and it seems like the pain is typically felt at the front of the knee below the kneecap. My pain is actually on the medial side above the arthroscopic portal, under which the scar tissue is obvious to the touch. I'm therefore not sure if fat pad impingement is what I'm suffering from, although perhaps the symptoms are more varied than the internet makes out















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