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Offline kathleenj

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Questions about plica
« on: August 25, 2004, 01:09:47 AM »
I have had 2 Oats within the past 8 months.  One was arthroscopic and the latest one was an open procedure in June.  The past month or so my plica has become very inflammed.  I saw my OS on the 6th of this month and he had me start Bextra for the inflamation.  It has done nothing.  He said he would do a cortisone shot but at that time I was still within my post op period and it was still too risky to develop an infection.  I have an appointment  with him next week and he said he would do the shot then if it hasnt calmed down.  I am beginning to get a bit desparate, and wanted so badly to call him and see him this week but he is on vacation.
I am also beginning to question whether or not the shot will even work.  I have done some research on the internet and from what I have read it is not too often that post op plica will subside with conventional treatments.  I have been taking the bextra, icing, going to pt for massage and phono treatments but it only seems to be getting worse.    The pain right now is far worse than the pain of my chondral defects and I feel like I am about ready to jump off a bridge. (not literally, but getting pretty close) To top it off, I cant sleep for more than 1 hr at a time because the knee aches so badly when it is still.  
Sorry to have gone on and on...I was just wondering what you guys know about post op plica compared to plica syndrome that develops without an injury or surgery.  Do I have a chance that the shot will work or is yet a 3rd surgery in my future?  Like I have said, I am beginning to get to my breaking point and any positive insight would be really appreciated.
Thank you.
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline Heather M.

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Re: Questions about plica
« Reply #1 on: August 25, 2004, 03:13:29 AM »
Are you sure it's plica as opposed to scar tissue?  They are both synovial tissue, I think, or at least signs of significant inflammation of the synovium.

Just curious.  I was sheduled for medial plication after having 'plica syndrome' appear after surgery.  When the doctor got in there it had nothing to do with plicae and everything to do with hyper-trophic scar tissue.  The nuances between the two are faint but there.  Treatment differs based on which one you have.  Often plica will show up on MRI, and in my case at least, scar tissue doesn't.

It just sounded familiar--I kept being told that I had plica syndrome and that it was something that sometimes happened after surgery.  But after a second scope it became clear that we had been barking up the wrong tree.  So your description rang a bell.  Scar tissue is one of the most common complications after OATS procedures.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline kathleenj

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Re: Questions about plica
« Reply #2 on: August 25, 2004, 03:35:17 AM »
Actually, I was told by my OS that I do have some bands of scar tissue that he can feel as well and we have been treating that with phono and deep massage.  Now, I am wondering if this is all just the scar tissue.  How can an OS tell the difference if they are both synovial fluid?  I mean, without an MRI.  Can they feel it?  He said that he can feel my plica inflamed as well as the scar tissue bands. My kneecap seems to be sucked down into the joint and it gets stuck everytime I try to straigthen it after it being bent... so much so that I need to physically pull it up and then straighten my leg. (yeah, I guess my knee is a mess)  Oh boy!!!  I had read so much about scar tissue and I was hoping that I wasnt heading down that infamous "arthrofibrosis" road.  The scar tissue definately makes more sense to me because I cant see how a plica can cause this much pain...but then again you never know.  I suppose I will need to take all of this up with my OS when I see him next week.
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline stgiles16

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Re: Questions about plica
« Reply #3 on: August 25, 2004, 05:02:15 AM »
Kathleen, I hate to tell you this but plicas can hurt ALOT.  I had mine after surgery number 3. It hurt worse than my chondral defect also. OS removed it during my next surgery and have not had any further problem with it. I did develop scar tissue in the fat pad after that and am currently 3 weeks post op for that one. ( Jeez, one little problem and surgery after surgery, new stuff just keeps popping up). Good luck, I tried everything but had to have surgery anyway so he just scoped it right out. NO more problem LOL.

Good luck
Missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline Heather M.

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Re: Questions about plica
« Reply #4 on: August 25, 2004, 09:38:52 AM »
If you have had scar tissue problems once, chances are that you can have them again if the same level of swelling and irritation were present after the surgery.  Scar tissue comes back very quickly.  Plicae I think are generally thought to be an indication of mal-tracking problems.  Scar tissue is the result of trauma and the body's attempt to heal itself after trauma.  I think plica can just appear on their own in some people who have PFS, whereas scar tissue is a response to something, usually surgical.  I'm told plica can also be the body's response to irritation, but it's more a case of the folds of the plicae already being in the knee and not symptomatic or bothering you, then tweaking and irritating them with trauma or mal-tracking.  The scar tissue would actually grow in your knee where it wasn't there before.

You are right, though, you'll have to talk to your doctor.  I only know a bit about plica because for a long time they thought that's what I had.  But it was scar tissue all the way.  Maybe the biggest indicator is the location--aren't most bands of plica found in specific places like the medial part of the knee?  Scar tissue can occur anywhere there is trauma.

Plicae are little folds of tissue--imagine the crease of your thigh, say, and then one of those folds gets inflamed.  So it becomes hypersensitive.  It can snap and catch and really hurt.  It was always there before, but probably not as big and tender.

Scar tissue isn't a fold of synovial stuff, it's actually a band of tissue that has a different make up.  It's got collagen and is soft, white, and smooth.  When it hardens I guess its appearance changes.

Anyway, I'm led to believe that plicae can show up on an MRI if the technician and radiologist know that is what is suspected before the films are done.  Scar tissue in my knee at least is more problematic--it has only shown up when it is a big chunk of old, hardened fibrous tissue.

If your kneecap is sunk into the joint, then you unfortunately will have to deal with the scar tissue sooner rather than later.  It's not good to let that junk sit in there changing your mechanics--it could easily be responsible for every bit of your pain.  Further, if it changes your knee mechanics by tightening everything up, it can grind up the articular cartilage that you have left--and the new stuff, too.  My OS won't do any cartilage restoration techniques on me until the terrible mechanics from the scar tissue are addressed--my kneecap has to be levered up out of the joint (infrapatellar contracture) and the kneecap has to be brought back up off the tibia, where it is now sitting due to patella baja.

Talk to your doctor.  If your last procedure was in June you can maybe do a lot of good in terms of loosening the knee up--ROLF therapy or very deep tissue massage, acupuncture, myo-fascial release, phonophoresis in PT, cortisone and SYNVISC shots...there are a few tricks in the bag.  And you should be on some kind of pain medication, because scar tissue and the cartilage damage it can cause HURTS.  Scar tissue can wrap around nerves and really inflame the knee.  I'm in constant pain from the effects of the scar tissue in my knee.

Talk to your doctor about what's going on in the knee.  And see if you can get better pain management and something like Ambien to help you sleep!  If the OS won't help, consider seeing your GP or a pain management specialist.

Take care.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline kathleenj

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Re: Questions about plica
« Reply #5 on: August 25, 2004, 04:44:11 PM »
It seems to me that I may have both scar tissue and plica.  My OS actually said he felt both.  Now I guess the tricky part is treating it.  Heather...you mentioned that each is treated differently...how is that?  If I have both causing problems in there, how do you typically treat that? Without cutting it out?  (I know, I am probably just wishful thinking now huh)  And just out of curiosity...how long do doctors typically wait before realizing that conservative treatments arent helping for both scar tissue and plica?  I am really looking at that cortisone shot next week as being my savior...am I dreaming?

Thank you both for your insight.  Sorry to bombard you with so many questions but with my OS out of town I kind of feel helpless and I dont know anyone else in the practice enough to trust them with my knee.  I wish he wasnt out of town this week, this knee is killing, my kids start school next and I have a million things to do.  Just the thought of going to the mall for school clothes makes me shiver.  To top it off I am supposed to head back to work in 2 weeks and with the knee like this I dont see it happening...I photograph kids...I need my knee to work!

right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja