plica syndrome?

[nikster140]

Hey guys,
I'm new on here and my first burning question is about a knee injury. Orginally it was a torn meniscus (back in may in Mammoth), the surgeon wanted me to do pt then evalutate it again in august.
When I go back, I'm having localized sharp pain on the medial joint line, starting up near the patella. He called it an inflamed synovial plica. I can actually feel the plica band under my skin.
Has anyone else ever had this? Could it be related to the meniscal tear?
He wants me to do pt again for a few months to see if it "goes away" then do a scope mid season. That just doesn't sound like a great idea to me, how am I supposed to convince a conservative doctor that I want to be 100% in a few weeks?
Any advice would be helpful, I'm in a good deal of pain!

-Nikki

[Viva]

Wow, at first I thought you were full of shit, because "plica" refers to the folds of the intestine. But then I searched Plica Syndrome and came up with all kinds of knee injury-related sites. So, for immediate chewing satisfaction, your best bet would be to do an online search. Vinman will help you, but he's not here so much lately.

[LightlyToasted]

You could always get a second opinion from a different surgeon if that's an option. Even if you had it scoped tomorrow, seems like being 100% in a few weeks might not be feasible anyhow.

[Vinman]

A plica is a fold/thickening in the synovial lining of the knee. Lots of peeps have them and don't ever know it. However on occasion they can become painful and cause problems.

Stuff like ultrasound or iontophoresis might help with the pain. Do like viva said and do some research on your own as well.

like Viva said, I'm not here as much lately due to a job change. I try to check in every night. Once I get the high speed intraweb thingy I might be on more...

[snowfire]

I have plicas in both knees. I've had knee probs for 6 years but I'm not at the point where I'm ready for surgery. I also have patellar fat pad irritation. Mine's due to crappy lower extremity alignment and lots of stress on my medial knee. What I'm doing for it now is helping... I'm doing a lot of PT focusing on strengthening the supporting muscles: quads, hams, glutes, and a TON of glut medius strengthening. Biking for the last 2.5 months instead of running. Running up to 30 minutes now and focusing on squeezing my ass every time I make initial contact. Focusing on not letting my knees land to the inside of my toes. It's doing much better and I'm progressing to plyos now. Not pain free all the time, but substantially less. Maybe strengthening won't help you, but it would depend on what a PT found in an eval and what your alignment's like. Strengthening certain muscles might help take the stress off your medial knees. You'd probably still have the plica but it might not get so irritated.

I don't think anything's going to get you back to 100% in a few weeks. Unfortunately (in my somewhat limited experience) knee problems usually aren't like that. I'm assuming you want the surgery now instead of trying PT first? It's your choice, but you may want to give PT a go before letting someone slice into your knee.

Where do you live? I'm sure people on here can give good PT recommendations for most areas.

good luck!

[nikster140]

Sounds like these problems just never go away...and I am trying to be realistic about the fact that when you are this hard are your body, you're not going to be pain free.
I have been in PT since May because of the meniscal tear. I did not have surgery for that injury. The plica could have started at that time or just during my rehab this summer. I also have a lot of stress on the medial part of the joint because of misalignment in my hips (pelvic torsion, one side higher than the other). If I can't run, that's fine because I hate running, but I just want to be able to take the impact of skiing and be able to make turns without significant pain.
I've also been wworking hard on strengthening the glutes, medial quads, hamstrings and adductors, and I'm probably in better shape than I've been in for a long time.
After being in PT for 5 months I'm just getting a little impatient. They keep putting off the arthroscopy thinking everything they do will work, and I just don't really have the time. I know it's stupid but I'm only 20 and feel like I should have a lot of time ahead of me before I have chronic pain.

How long do I give the PT before I give up because it hasn't been helping?

-Nikki


I'm in boulder by the way, doing PT at Boulder Orthopedics PT on Alpine.

[Froman]

Definatly get a second opinion - Go see Dr. Paul in Boulder - he's surgon with Boulder Orthopedics on Alpine.

If you don't like your PT program, try Boulder Center for Sports Medicine, also in the same area on 4th and Mapleton.

I was in a similar situation about five years ago - slightly torn meniscus, no surgery and plica bands formed. After about three months of PT with BCSM, the knee got a lot stronger, and the plica got smaller. They are still there, I can feel them under my skin, but they don't hurt like they used to.

Good luck and heal up fast!

[nikster140]

Thanks for all the help you guys

Froamn - I knew someone on here would have had the exact same problem as me. It's funny, because Dr. Paul is my doctor, and he is wonderful. I've just been in PT for 5 months now for all of this, and although I am much stronger, I am actually in more pain than before.
Is this just a pain thing or am I actually more likely to injure myself once I start skiing?

[Froman]

Nik-

Have you talked to Dr. Paul about wanting to be able to ski this season? I'm sure you know he is very active - he'll understand your desire to ski this year and he'll do his best to help you delay or avoid surgery. That said, I'd listen to him, which might mean surgery mid season. The last thing you want to do is cause further damage to your knee. It might suck, but its just one season - and like you said, your only 20 - you've got a lot more skiing ahead of you.

I'm suprised he didn't refer you to Boulder Center for Sports Medicine (BCSM) right away.

For me, The pain went away with PT, as did the plica (not completly, but they got smaller). I'm not sure why it is getting worse for you - maybe your PT is too agressive. How much of your time is spent streching and low or no resistance strengthening, and how much of your PT is spent on dynamic movement and plyos?

My advice - go to a PT at BCSM, PM me for a name if you want a recommendation, but they are all good. Make sure to communicate your problem with the PT, esp the part about doing PT for 5 months and being in more pain.

Good luck, heal up fast, and let me know how it goes for you.

[peterslovo]

I've been struggling with both plica syndrome and pes anserine bursitis in my right leg for about 4 years now - one is causing the other, but we aren't sure which, or why. They thought it was torn meniscus for a long time since the MRI was "inconclusive", but it has not been scoped.

Definitely worse with any activity requiring repetitive motion - biking, hiking, running, skiing. My bike setup is good, hamstrings are a bit tight but better, and hip flexors fine. Definitely a weaker VMO on my affected leg, but PT did not work (as it actually tends to irritate the plica and pes anserine bursa, which shuts down the VMO making rehab counter-productive), so my orthopedic is trying a cortizone injection to calm things down.

I'll post when I get it to see if that helps as an option for you to consider as well.

[Jim S]

Plica are extremely common. So common that you almost have to rule out other pathology before attributing the symptoms to a plica. I would say that of the MRIs I read, all of which are in symptomatic people, the majority have plica.

Good luck.

[hurtgirl]

I believe I have Plica in both knees. I have been trying everything for 3 years now to try to get it to settle down but nothing brings relief. I can barely walk now and I need a surgeon to listen to me and do something about it.

[hurtgirl]

What did it take for you guys to get the surgery done to correct the Plica.

I have been doing all the physio, icing, etc.

Just looking for some help or a doctor who handle this type of problems only.

[Summit]

Dr. Steadman performed Plica surgery on my cousin this fall.

[hurtgirl]

Where is Dr Steadman located? I need to get this Plica problem fixed. Any other suggestions for good doctors? I am from Canada and wait times are terrible.

[Summit]

Steadmanhawkins clinic in vail/denver. They are probably the best in the world.

[hurtgirl]

Thanks for your reply. Could you just tell me if you know are wait times long for that clinic?

[Summit]

No idea. Days to a few weeks or two id guess. Call them