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Date of last update: 10/01/2017.

Forum Name: Joint surgery

Question: Failed Medial Plica Knee Surgery

 aparks2001 - Wed Jan 07, 2009 1:18 pm

I am a competitive cyclist and have been involved in the sport for years. I train 15-20 hours per week. I havel also stretched and lifted weights regularly for 12 years, and have never been injured. In Feb of 2008, after taking several months off completely, I ramped my training back up. After 2 months symptom-free, I quickly developed medial knee pain in my left knee. I should note that the only thing that was different this year was that I moved my saddle forward to experiment shortly before the pain began, but then moved it back after. I also learned to snowboard in January and spent about 3 hours falling on my knees (no obvious injury, just a bit sore). This may have initiated the inflammation.
After months of RICE, PT, chiro, NSAIDs, and several orthos, I was diagnosed with a plica. Arthroscopic surgery confirmed and removed the plica, which was rubbing a groove in the femoral condyle. All other aspects of the knee were pristine I am told. Within 2 months I was getting back into training with no pain, when the pain developed in my right knee this time. Same diagnoses was made, and confirmed by arthroscopy.
It has been about 5 months post surgery (left knee) and 2 months post surgery (right knee). I was just getting back into full training when the pain again developed in the left knee. This time I can very easily feel a band where the plica was removed snap over the FC when I squat or cycle. The surgeon informed me that she removed the fold down to the base of the synovial lining (common practice and she is a very well-known surgeon with 35 years experience in the knee).
My theory is that the base itself was not excised. Basically, the tree was cut down, but the stump was left. I have read literature that suggests that removal of the retinacular band at the base of the fold greatly improves the success rate. This makes sense to me, but it seems that all of the orthos I have spoken with do not really want to talk about that.
I would greatly appreciate any advice you have to give regarding this. I am almost at the end of my rope.

Thank you.
 Tom Plamondon PA-C - Thu Jan 08, 2009 8:07 pm

User avatar Andrew,
Thanks for the post.
Is there any catching or locking of the knee? It seems as if the base of the plica were not removed and now inflamed, it may catch or pinch in the knee.

If the tenderness is rather superficial and not intraarticular, you may get along with conservative treatment and making sure the quads have balanced strength and hamstrings are properly lengthening thus decreasing anterior knee forces.

Some runners with chronic tendonitis use a mix of salicylate and menthol ointment topped with a heating pad for 20 minutes 1-2 x a day for a week.

Let us know how it goes.
 aparks2001 - Tue Jan 13, 2009 8:58 am

Sorry it took so long to reply, I did not receive a notice that anyone had replied. No, there is no locking of the knee per se (no loose bodies or internal locking). The catching is 100% superficial to the joint. It is plainly obvious what it is, as the band is clearly palpable and I can feel it snap over the medial femoral condyle with my finger at flexion. Also, the pain is localized to the band and only appears when I flex enough for the snapping to occur. Weird thing is, I do not remember it being this obvious before the surgery although the pain was worse (this could be because the fold was removed but not the base).
At any rate, no amount of PT, RICE, etc will work...I have tried it all. Further, my muscles are very strong and balanced as I have consistently done gym work for over 10 years along with riding. For legs, I do 8-10 sets of squats with varying stances, 7 sets of hamstring curls, several sets of calf raises, and a few hip flexor and groin exercises. I do this twice a week with good form and not alot of weight (max is maybe 180 lbs for squats). I also stretch almost daily and am very flexible.
So it's not a condromalacia, meniscus, tendon, etc issue. I have also seen the pictures of the surgery and my cartiledge looks great.
You say it sounds like the base was not removed. I agree with this, but why would the base not be removed? The way she described it, she "bit" out the fold down as close as possible to the base as she felt comfortable with. I have read that you want to avoid going so far that you insult the synovial lining, but how else would you remove the underlying base/band?
I have an appointment with Dr. Martin Boublik at the Steadman-Hawkins clinic in Denver next week, but I want to get as much info as possible before my appointment. Also, I would like to know opinions of the clinic, if there are any out there. Thanks alot.
 Tom Plamondon PA-C - Tue Jan 13, 2009 10:41 pm

User avatar Andrew,
It really sounds like you have covered everything.

I think the question now is what should be done about this knee. If indeed residual plica is inflammed do you continue conservative treatment or do another scope.
You'll discuss with the ortho doc at the next visit.

Take care and let us know how it turns out.

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