Wednesday 25 August 2010

Plica Removal and Patellar Chondroplasty: Two Weeks Since Surgery

Doing well now. Stitches and dressings came off two days ago and the incisions have healed nicely. Mostly I'm a bit sore and stiff. I can get up stairs fine, down is still a bit tricky - but I'm getting there. Went for a 35min walk yesterday with no problems. Stuck to all the physio exercises I was given by the hospital and went for my first appointment with my normal physio since the op. She tweaked my routine to just the following:


  • Leg raises with a towel under the knee (see earlier post)
  • Knee bends (see earlier post)
  • Some mobilisation of scar tissue on the upper incision (apply sliding pressure across it against the grain of the muscle fibres)
  • Carry on icing to get the rest of the swelling down. Also ice the back of the knee as swelling there is preventing full extension of the leg (don't force it!) and probably causing the calf muscle pain
  • Dips on a small step (just like going downstairs) - making sure my knee goes over my 2nd toe and my hips are level
  • Carry on with walks as far as is comfortable - but don't limp, strong core and hips level
Here's what is still troubling me:
  • Calf is very sore still
  • Cannot quite push the knee to full extension with getting a stuff, 'bulgy' feeling at the back
  • The upper incision is standing out a bit - with a sort of gristly feel. Physio felt there is where the instrument pushed aside muscle tissues and I need to mobilise it to prevent scar tissue forming. That area is still quite sore
  • Going down stairs I still feel tentative and tend to twist and drop my other hip rather than bend my knee properly - naughty!
  • Still some swelling above and below - but not too much (see photo)
  • Lost some definition and bulk of right quads despite exercises
Here is what it looks like now:

Thursday 19 August 2010

Plica Removal and Patellar Chondroplasty: 8 Days Since Surgery

Rubbish today. I really noticed coming off the pain/inflammation meds (diclofenac). Felt stiff and swollen when I work up and I felt more sore and 'vulnerable' than yesterday. Got some cocodamol so that should take the edge off it. Felt like a psychological blow to find stairs so hard again (yesterday I had been able to go up and down pretty normally, albeit with a hand on the rail). I still went out for a walk and also to the shops - it does seem important to keep mobile and not to let myself slip back - but took it all pretty easy. The incision which has been sorest all along is the the superior lateral one (where the RF went in - see day 0 post) and that one really flared up. The inferior pole of the patella is painful as well when the knee is at full extension and lightly loaded (when doing physio or standing for a while) - before today I only felt that if I tensed the quads quite hard. Calf is still very sorry - icing it last night helped but only for a while.

Hopefully this is just a blip and over the next few days I'll carry on improving like I have been to date. On the plus my stomach is so happy to be spared the dicolefanc. Another plus is that the area where the plica was removed seems to be settling down and 'catching' it when turning is much less common (but still a nasty shock when I do)

Here's what the knee looks like now (looked better than this yesterday - I could see the edge of the patellar in places then):
Day 8

Wednesday 18 August 2010

Plica Removal and Patellar Chondroplasty: 7 Days Since Surgery

Good day today. Over the last four days I have gradually transitioned to being up and about all day, going out for very shorts walks (10 mins) and being a bit more active around the house. Drove myself to the doctors today - which felt like a big step forward in terms of life getting a bit more normal. Also walked for 15mins which was nice - lovely to be in the fresh air. I went to the docs because I've had a very sore calf since the op which has not really improved (in fact got a bit worse). I was worried that this might be a blood clot which I had been warned to look out for as it is a possible (albeit rare - 1:750) complication. Was relieved that the discolouration was only a bruise (either from me rubbing it or from the op) and the pain was in a muscle area rather than a deep vein area. Guess it's just a side effect of the stress to the knee and all the swelling draining. In retrospect I have not been doing enough to keep my ankle raised - which has probably not helped. Guess I'll just ice it, ignore it and it'll go away eventually. In case anyone else gets this problem, here is why the doc discounted it being a clot/DVT:

  • No heat from that area
  • No redness (the marking was a bruise)
  • Pain was on the medial part of the calf muscle and not 
  • Pain was sore rather than severe
  • No swelling
Onwards and upwards........I'm coming off the diclofenac today (thank god - it's killing my stomach) so I reckon I'll feel a bit worse over the next few days.....

Friday 13 August 2010

Plica Removal and Patellar Chondroplasty: 2 Days Since Surgery

Very sore, tentative and ginger. Stairs are too hard and I can only do them by crabbing. I'm still mostly resting in bed, but doing my physio every couple of hours and pottering about a bit. The swelling is going down quickly (see photo). Mostly I just get soreness, apart from if I rotate the upper leg on top of the lower (e.g when turning without moving feet) and then I sometimes get a sharp pain - exactly where I used to get my flare ups and catching/cracking noise - so I'm avoiding that like the plague :). The cryocuff the hospital gave me (knee sleeve that you fill with ice/water and pump up with air) is brilliant and is really helping to get the swelling down and manage pain .The diclofenac is already starting to irritate my stomach - knew it would. Basically going well - but them I'm not really doing anything....
Day 2

Post-Operative Physiotherapy Routine for Arthroscopy




Wednesday 11 August 2010

Plica Removal and Patellar Chondroplasty: The Operation

Operation seems to have gone well. The surgeon found (and removed) the medial plica which was inflamed. There was also some degeneration of the lower, medial patellar cartilage which he tided (and hopefully stabilised) with radio-frequency. He did not remove any tendon material as he felt that the above two would dramatically reduce the pain I get - sounds good to me!. Walked out (albeit very gingerly) 5 hours after the op - no doubt made easier by the long lasting anaesthetic inside the knee joint. The swelling of the knee is enormous (yuck!). Check out this photo I took once I got back to my room.
Day 0
I think the medial incision is where the scope went in, the lateral one is where surgical implements went in and the superior lateral one is where the RF was introduced. For pain management I have been given diclofenac (twice a day) and paracetamol (4 times a day). Have also been given a basic physio routine to be followed until the stitches out. This routine seems geared to maintaining some mobility and muscle strength/firing. I'll put that up in a separate post in case it is useful to anyone

Monday 9 August 2010

Plica Syndrome

Interesting this.....ages ago a physio once wondered if I had a plica problem and it came up again with my consultant. So, what is it?
"Often called "synovial plica syndrome," this is a condition that is the result of a remnant of fetal tissue in the knee. The synovial plica are membranes that separate the knee into compartments during fetal development. These plica normally diminish in size during the second trimester of fetal development. In adults, they exist as sleeves of tissue called "synovial folds," or plica. In some individuals, the synovial plica is more prominent and prone to irritation.The plica on the inner side of the knee, called the "medial plica," is the synovial tissue most prone to irritation and injury. When the knee is bent, the plica is exposed to direct injury, and it may also be injured in overuse syndromes. When the plica becomes irritated and inflamed, the condition called "plica syndrome" results."


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That really is very consistent with the medial problems I get (but not those directly above and below the patellar). Good news is that the best diagnosis (and treatment) is via arthroscopy) - which I am having, so it should get picked up. Of course by the time I've had the artoscopy itself, plus tendon decompression AND plica removal it could take a long time to get back on my feet....no point second guessing...just have to see what comes from the arthroscopy

Arthroscopy: Going in for the Op!

Well, finally decided to have an operation on my knee! Decided to go for it now because I'll have my long Teacher's summer hols to get past the initial soreness and get back to driving. I've scanned in some of the details of the consultation here:

Although I initially decided to wait longer, one relapse too many and the offer to 'go private' from my very kind parents (thanks mum and dad!) changed my mind. I'm having an arthroscopy to check for other problems  followed under the same anaesthetic by decompression of the tender parts of the tendon. It feels like the right thing, with the physio and the walking I have regained good mobility but have plateaued now - hopefully this operation can correct the remaining stubborn problem and I can further increase my function beyond that. Feel quite nervous about going back a few steps, the level of pain I might be in after the op and also the (albeit very low risk) possible complications - but I'm just not ready to give up an accept that this is a good as it will ever be. Discarding the possible nasty complications the worst case is that I end up much better informed as to what is wrong and can get on with my life without 'wondering what if'. Likely case is that I do get a further reduction in symptoms (studies of arthroscopic decompression seem to show good results, for example a and b) and best case is that I get substantial improvement.

I'm going in on weds - just keen to get on with it now....fingers crossed.....