Plica Syndrome anyone?

[Grammy57]

Hello,
I'm sorry this will be long. In 2017 the Dr did an arthroscopy (nothing showed on X-ray or MRI) he said it was plica. He said plica was a ridge on the tendon and this ridge had worn a groove in my kneecap. He clipped the ridge and all was well for about 2.5 years. My knee started hurting again, progressively worsening. It is now at a pain level of 4-6 daily and is interrupting my daily activities. I saw a new surgeon today (long story why new one) and he took x-rays. He said there was minimal space loss and after pushing on my knee and lower leg he told me it was plica again. He told me plica was a thickening of the tendon. He gave me a PT 'script that states pes anserinus tendonitis (primary) and the plica. On my after-visit summary, it also states acute internal derangement of the right knee. He also gave me a steroid injection and said if PT doesn't help he'll re-evaluate. My questions are which Dr is right about plica? I was told it was rare for it to return but this Dr says it's not? I would like to see a second Dr but he's in the same system though not the same office. I'm afraid he'll just dismiss me and say Dr. D is right and it will be a waste of time and money. Advice? I plan to do the PT and take the Meloxicam he prescribed but I'm afraid it will be like my hip, nothing was found there until an arthroscope was done and it was bone on bone but in the center on the outer edges as normal. I had THR in 2019. Thanks.

 

[benne68]

Hello @Grammy57. I so sorry to read that you are struggling with your knee and can't get a definitive answer.

I have no personal experience with plica syndrome to share, but I did find the following information in my research:

"Plica syndrome can reoccur if the plica membrane is irritated again. In chronic cases, the plica will become thickened and fibrotic which means it is less flexible and more likely to get caught. It is therefore more likely to reoccur as the plica is more likely to be impinged.

"Surgery for plica syndrome involves removal of the whole or a part of the plica. It is uncommon for the plica to regrow and cause symptoms again. However, if only a small portion of the plica was removed and if the plica thickened and fibrosed as it scared from the surgery then it is possible to cause symptoms again.

This seems to be consistent with what your new surgeon has said.

I also found a lot of information indicating most of the time, plica syndrome can be managed with non-surgical treatment, including

• Applying ice or cold compresses: Icing your knee helps reduce pain and inflammation. Apply a cold compress for 15 minutes every three hours.
• Non-steroidal anti-inflammatory drugs (NSAIDs): Over-the-counter medications like ibuprofen and naproxen sodium help reduce inflammation and discomfort.
• Steroid injections: Your healthcare provider may recommend corticosteroid injections to ease your knee pain.
• Exercises to strengthen your quadriceps: People with weak quadriceps are more likely to develop plica syndrome. Exercises that target your quadriceps can help reduce your risk.
• Hamstring stretches: If your hamstrings are too tight, they can place extra stress on the front of your knee. Stretches that relax your hamstrings can help.

Hope this is helpful. Perhaps another member who has experience with this problem will stop by. You might want to change your thread time to something like "Question about Plica Syndrome". to attract more attention.

 

[Jaycey]

@Grammy57 I changed your thread title so that any members with experience can come and chat here.

 

[Jamie]

I did a search of the forum for “Plica” and there were some past members who either had the condition or thought they did. Although most are not active on BoneSmart right now, you can at least read their threads and see what they were experiencing. You’ll find the Search link in the tool bar at the top of the page.

 

[dotski]

Hi Grammy57. I have medical plica syndrome. I'm scheduled for a total knee replacement soon. The plica syndrome has been the most debilitating part of it, but there was too much damage for a simple arthroscopy...when it would only accelerate damage elsewhere.

2 out of 3 of my joint compartments have full thickness cartilage loss, even though the bilateral weightbearing xrays ("standing AP") don't show full collapse. It's only when you do a single leg weight bearing xray where you can more clearly see on a plain films xray what is going on (or MRI). The patella xray view (skyline) doesn't always tell you much either - it can show a lot of joint space because the film is taken lying down....not hobbling down a set of stairs!

So I would not be at all surprised if you have a lot more arthritis in the joint than the xrays show. A good surgeon will be able to tease this out with a full knee clinical exam.

Have you had an MRI?

Plica syndrome is not a tendon problem. Tendons attach muscles to bone. The plica is part of the lining of the knee, not a tendon. But I suppose once it gets scarred/thickened then it might behave like a bad tendon in the wrong place, rubbing the heck out of everything around it! The PT treatment for it might be similar to pes anserine bursitis (hamstring/adductor stretching, general strengthening, etc.), and often clinicians can confuse one for the other because symptoms are similar and in a similar location. So it's possible you may have one or both diagnoses. During knee bending/straightening, you would be able to feel the band snapping across your femoral condyle (bump on inside of thigh bone at knee) if the plica had grown back (ie the remaining membrane tissue decided to grow scar tissue). It would be most noticeable during a single leg squat.

Plica syndrome is not a common diagnosis that most PT's see often, so I wonder if your surgeon wasn't sure if it was one or the other (plica vs bursitis)....or just wanted to list a diagnosis that the PT would recognize. I saw 3 PT's and none of them identified plica syndrome as the problem, nor did my GP. I saw a chiropractor and he identified it, but by that time I had I self diagnosed anyway. Later an MRI very clearly confirmed it. It was obvious by then - very scarred and a visible lump to the medial side of my knee cap.

But definitely all of the exercises that a PT will recommend will be of overall benefit to the health of your knee. It may not stop all plica symptoms. But it will show your surgeon you are serious in that you worked hard in PT, and maybe help to justify further surgical intervention. My personal motto is that I have a responsibility to put in the work (stretching MULTIPLE times daily, daily exercises), live a healthy lifestyle and stay in a healthy weight range. I would push for an MRI and xrays that test your knee in a single-leg weight-bearing (standing) position...to get a more clear diagnosis.

From the research I did (pubmed, journal articles), surgery for plica syndrome is typically only effective when there are no significant degenerative changes (OA) in the rest of the knee.

My surgeon knew this also and said there was no way he could do a scope as he didn't think it would help me...and the only option he offered was a total knee. He of course wanted to exhaust all the non surgical measures, injections, etc. Hyaluronic acid didn't help. PRP helped a few years ago, but not most recently (there was too much damage second time). I'm only in my early 50's.

Good luck!

 

[benne68]

Hello @dotski and welcome to BoneSmart!

Why don't you start your own thread in the Knee Surgery Pre Op area to tell us more about yourself, including when you are having your surgery. Other members will be more likely to reply to you there.

Here's some info on how to do it: https://bonesmart.org/forum/threads/starting-a-new-thread-and-posting.57719/

 

[Grammy57]

@benne68 I haven't posted there because I am not scheduled for surgery. At this point the Dr doesn't want to do surgery though I'm suspecting it will eventually happen.

 

[Grammy57]

I started PT this week. All went well on Tuesday, my first day. They are working on strengthening my muscles to stabilize my knee. It was not painful until Wednesday when I could barely stand to be on my feet as my knee hurt so badly. And it was definitely my knee and not the connecting tissue or muscles. Today all went well and my knee is slightly sore. We'll see how tomorrow goes. Is it normal to have so much knee pain a day after PT?

 

[Jaycey]

Is it normal to have so much knee pain a day after PT?

Is your PT forcing your knee in any way? If so, yes it is painful. But forcing the knee is not necessary.

Are you icing and elevating after PT?

 

[Grammy57]

s your PT forcing your knee in any way? If so, yes it is painful. But forcing the knee is not necessary.

Are you icing and elevating after PT?

No, it is just exercises to strengthen the surrounding muscles. Bridging, leg lifts, light stretching. I'm fine the day of PT, but not so good the day after. Yesterday was my 2nd day and I'm again worse today. I have 3 more weeks to go. I did tell the PT assistant.

 

[Jaycey]

Bridging is for core stability and is probably very hard on a tender knee. Leg lifts will cause discomfort. How many reps are you doing? Gentle stretches are fine if it stays gentle.

If you are feeling sore and tender after PT I really can't see how it is helping.

 

[mendogal]

My anecdotal two cents: my arthritis didn't permit bridging or anything involving knee bending under weight load. Bridging can work the hamstrings as well as core, but @Jaycey is 100% right - very traumatic on an arthritic knee.

I had preop PT and we ***worked together** to find knee-sparing exercises - no stretching - that I did twice a week at home with zero knee pain:
-- straight leg raises, one leg at a time, first engaging the quad and then raising slowly and not high off the ground, for the quads
-- sidelying clamshells, slowly and with proper positioning, for the glutes