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Plica Excision & Chondroplasty Experience
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Hi--I wrote this about my experience with knee injury/surgery/recovery over the past 6 months and thought it might be helpful/interesting to some of you out there.
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About six months ago during a swim workout, I felt a little “pop” in my knee that I figured was just that normal “cracking” sensation that happens from time to time. I kept on swimming, but my knee felt pretty weird. When I got out of the pool and tried to stand up on the pool deck, my knee was swelling up and it felt too weak to stand on or walk properly. I knew something was wrong and immediately assumed the worst. I had my last race of the season coming up in a week and a half, and based on all my recent workouts, I was ready to crush it. Until now. Hoping that I’d just hyperextended it, I took it super easy and crossed my fingers that I was just being dramatic, as usual. So many thoughts ran through my head: “I won’t be able to race!” “I’ll have to take a couple weeks off!” “This is the worst thing that could possibly happen!” Except this time, what I’d thought was the “worst-case scenario” wasn’t even close. It was so much worse.
In the following months, I saw various physical therapists and chiropractors, none of whom could truly fix my problem. This included pain, clicking, and catching in the joint that would come on very suddenly and unexpectedly, along with a sharp, stabbing pain behind the kneecap which accompanied stair climbing and running. The early diagnosis was patellofemoral syndrome along with plica syndrome, neither of which were improved with physical therapy and time off. For those that don’t know, the plica is a vestigial tissue in the knee that can become inflamed when tight quads muscle imbalances pull it tight across the head of the femur during flexion. So, I worked really hard on my quad flexibility and glute/hip strength for a couple months. After November and December passed with no changes in my condition, I finally went to an orthopedist in early January who gave me a cortisone shot to calm the stubborn plica down. This worked temporarily, as the swelling and the catching stopped and I was able to return to running, biking, and skiing, but the sharp stabbing pain behind the kneecap that I’d been dealing with for almost 2 years now was not getting any better. Upon returning to the orthopedist a few weeks later, he finally agreed to do surgery to remove the plica, and smooth out the cartilage on the back of my kneecap that was likely worn away due to poor patellar tracking and overuse. An earlier MRI had shown that there was indeed some degree of cartilage damage to the back of my kneecap (stage 2-3 chondromalacia). Finally, in early February, I went under the knife.
Once the surgeon went into my knee with the scope, he found a little surprise that no one would have been able to guess from the outside. The damage to the cartilage on the back of my kneecap was not a gradual erosion from overuse, but a jagged fissure that was caused by an acute trauma. There was even a stray piece of cartilage that had chipped off and had been floating around inside my knee for who knows how long. After thinking about this for a long time, I finally remembered a fall when I was about 8 years old in which I smashed my kneecap into a stone stair and wound up on crutches for a couple days with a bruised kneecap. The surgeon concurred that this was the likely culprit responsible for the damage. They fished it out, smoothed out the crack, and removed the plica. Here’s some pictures:

Top Left: Zoom-in on crack in kneecap cartilage Top Right: Crack in kneecap cartilage Middle Left: Rogue cartilage chunk Middle Right: Healthy ACL Bottom Left: Healthy Meniscus Bottom Right: Super zoom-in on crack in kneecap cartilage
After surgery I was excited. No amount of physical therapy was going to get rid of that rogue cartilage chunk, so I felt good knowing that surgery was 100% necessary. My surgeon told me to hop on the bike the very next day (seriously) and I assumed it would be a quick and easy recovery. I read everything on the whole internet about plica excision and chondroplasty, and assumed (like the other sugar-coating, backdoor-bragging triathletes who’d posted about having this done) that I’d be running 10 miles a week out from surgery. Well, you know what they say about when you ASSume…
This has absolutely been the hardest thing I’ve ever had to deal with. The uncertainty and unrealistic expectations due to that uncertainty have been a huge struggle. Sometimes I wish I’d had a more straightforward injury with a more predictable recovery period. This has been the daytime soap opera of injuries—so many ups and downs, the drama, the tears. The agony of listening to my friends unknowingly flaunting their athletic endeavors in my face all winter long. I can’t tell you how many times I actually thought “Wow, I’m literally never going to be able to run again” or “Racing pro? Yeah, THAT was a short-lived dream” or “Well, I’ll quit triathlon if I can just be able to walk again”. I haven’t read anything that has helped me cope with my situation or prepare for the reality of the shittiness that is recovery, so I am writing this for anyone out there who is just starting out on this journey. And of course, in the grand scheme of things, this is definitely not the worst thing that has ever happened to anyone. In the week surrounding the Boston Marathon, we are ALL reminded of how much worse things could be. But sometimes when something like this happens to you, it can FEEL like the worst thing in the world, especially when your life (aka triathlon) is taken away from you. I can say from experience that the commonly recommended techniques of learning how to cook or knit or play an instrument, playing video games and watching Netflix, or drinking lots of beer are not going to make you feel any better. I think if I could have had more realistic expectations of what this would be like, it would have been easier to handle, if only slightly.
…and this.

Played a lot of this…

…and this.
Now it’s almost May, and after months of physical therapy and 35K swim weeks, I’m finally back on my bike. If nothing else, I at least won’t be DFL out of the water this season. There’s still some occasional swelling and weird sensations in the joint, along with pain behind the kneecap. My legs get sore from biking 30 miles. It’s never going to feel the same as my other knee. But I successfully completed my first “run” around the block yesterday. I’ve started going up and down the 3 flights of stairs to my office instead of using the slow-ass elevator. Things are finally starting to look up, just a little. Maybe in a few more weeks, I’ll be running a few actual miles. Maybe.

Photo evidence of first post-surgery bike ride (easy 20 miles at a snail’s pace)
As a side note, if any of these issues are plaguing you, or you are set to have any of these procedures done, feel free to reach out and ask me anything you want to know. No bullshit, I promise
https://carolynpfalzgraf.wordpress.com/2015/04/21/the-long-road-to-recovery/
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Re: Plica Excision & Chondroplasty Experience [carolyn] [ In reply to ]
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Glad to see you are getting back at it! No doubt all that swimming will pay dividends.

All the best going forward! Hope to see you at the races :)

Emily Sherrard
@EmSher1
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Re: Plica Excision & Chondroplasty Experience [carolyn] [ In reply to ]
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Carolyn,

Awesome blog. You and I have experienced very similar knee injuries and surgeries. (me X2). Keep us posted on your road to recovery.

Tim T. http://longlegsandbigwheels.blogspot.ca/
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Re: Plica Excision & Chondroplasty Experience [titemple652] [ In reply to ]
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Thanks, Tim. I read through your blog and it seems like your knee issues have been even crazier than mine! How are you doing these days?
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Re: Plica Excision & Chondroplasty Experience [carolyn] [ In reply to ]
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Carolyn,

Hanging in the there. I did two rounds of PRP (Nov and Feb) which has helped me to at least get back out on the road even if I can't push much power or do any sprinting. Power for me 2 years ago was ftp340watts now I am no where close to number that but I can go out and get some exercise with my friends and local cycling club. I can't run at all though.

I have a solid diagnosis and will soon see a specialist in Toronto to finally correct the problems in my knee, hopefully in late Aug. Specifically, Medial Patellar Femoral Ligament/Retinaculum problem and another torn medial menisus. And some knee cap cartillage issues as well.

Tim
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Re: Plica Excision & Chondroplasty Experience [carolyn] [ In reply to ]
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Carolyn: What's the date of your surgery, how old are you, how's the opposite knee, how much does the knee swell now?

Also, you are an individual, the only one like you, so your post-op course will likely be different than others as well.

PM or email me if you wish, I've seen lots of these. john@johnpostmd.com

Best wishes,

John

John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA
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