Login required to started new threads

Login required to post replies

Plica Syndrome and Cortisone
Quote | Reply
Went to the doc this morning after months of dull pain in my left knee. I was diagnosed with plica inflimation on the medial side of my knee. I was given a cortizone shot and told to check back in about 5 weeks to monitor progress, i'm allowed to train lightly between now and then.
My knee feels like i've lost a few degrees off the range of motion and kind of funky after the injection. Any ideas how long this feeling will last? Anyone else have to deal with inflamed plica? How long did it take to heal up?

Thanks.

Jonathan Blyer,
ACME Bicycle Co., Brooklyn, NY
Last edited by: jonblyer: Feb 9, 07 13:49
Quote Reply
Re: Plica Syndrome and Cortizone [jonblyer] [ In reply to ]
Quote | Reply
48-72 hours, although your orthopedist should have mentioned to lay off for 1-2 days post injection. I'm sure Rockchalk can shed more light re: this though

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
Last edited by: rroof: Feb 9, 07 12:37
Quote Reply
Re: Plica Syndrome and Cortisone [jonblyer] [ In reply to ]
Quote | Reply
I had some plica removed in the 80's via scope and have had no problems since. I was riding in about a week...

Funny, no one talks about plica anymore...

Good luck
Quote Reply
Re: Plica Syndrome and Cortisone [skeeter] [ In reply to ]
Quote | Reply
Thanks, that's good news at least, thanks. I'd like to avoid the scope if possible.

No one does talk about it, I searched it (didn't want to get yelled at) and only came up with about 8 hits.

Jonathan Blyer,
ACME Bicycle Co., Brooklyn, NY
Quote Reply
Re: Plica Syndrome and Cortizone [jonblyer] [ In reply to ]
Quote | Reply
I recently had surgery (4 weeks ago today) to clean up my knee. MRI's didn't pick it up the problem. 4 weeks of no running didn't help. Ice/anti-inflam meds didn't help. I was never "told" I had anything...surgery was the last resort. My doc and I thought that we had jumped through enough hoops...it was time to "go in". One of the things my doc "fixed" was to trim the plica that was causing irritation to my femur. Meniscus was not torn (although very thin - he did end up removing 30% as a precaution).

I first experienced the pain just after IMWI in Sept...I waited 4 weeks to see the doc...went through 2 weeks of testing (MRI's)...6 weeks of PT to try to fix the problem...and then 2 weeks to wait to get surgery. All in all I will be out 6 months...I wish I had the foresight...

FYI - My knee pain allowed me to run between 90 seconds and 6 minutes without pain. The 6 minutes was before PT (and after) the 90 seconds was at the height of my pain. I could always bike about 60-75 minutes w/o much pain. I had no ROM issues.

I am in recovery week 4 and can already sense that things will be better. I am biking 60-90 minutes w/o pain...but have yet to run.

Good luck with your knee. I found this site gave a good overview of the Plica issue. http://orthopedics.about.com/...rmation1/a/plica.htm

PM or ask here if you want more specifics about my injury (or surgery/recovery)



******************************************************
Well I believe in God, and the only thing that scares me is Keyser Soze
Quote Reply
Re: Plica Syndrome and Cortisone [jonblyer] [ In reply to ]
Quote | Reply
I made a mistake several years ago and allowed a "sports doc" to give me cortisone shots in the medial sides right below my knee to give me relief from pes anserine tendonitis (duck's feet tendons that wrap around from the back of the hamstrings).

The cortisone literally ate away the flesh under my skin. I had "divots" on the insides of my knees where the fat or tissue underneath the skin was gone.

It grew back within about a year. Weird.
Quote Reply
Re: Plica Syndrome and Cortisone [jonblyer] [ In reply to ]
Quote | Reply
I had plica irritation twice. Both times were during heavy training and I was mostly interested in getting through the upcoming event. Both times the DR gave a shot which helped (along with ice and tapering, which was about the time for it anyways). The Dr said if the shots didn't work surgury was an option and that he didn't want to go the shot routine too often (mine were a year or two apart). I haven't had a flare up in 4-5years. The Doc also said that it was OK to work through the pain as I would be highly unlikely to cause any permanent damage, but be careful because at its worse it hurt like hell (and this is from someone who once had stiches put in his penis with no anesthetic, but thats a different story).
Styrrell
Quote Reply
Re: Plica Syndrome and Cortisone [jonblyer] [ In reply to ]
Quote | Reply
That's kinda funny because I had a cotizone shot yesterday morning (lateral side of patellar tendon, but deep) and noticed my knee to only go about 95% extension for the most of the day. It's back to normal function today and there is no pain from the shot. You should be fine real soon!
Quote Reply
Re: Plica Syndrome and Cortisone [jackbauer] [ In reply to ]
Quote | Reply
The divots are normal according to my doctor for the reason you stated, the fat was taken away and there was "nothing" there anymore. Thus, it created a divot.
Quote Reply
Re: Plica Syndrome and Cortisone [jonblyer] [ In reply to ]
Quote | Reply
You will more than likely feel some sharp pains in the area tomorrow. The cortisone crystallizes or something like that and gives a bit of pain.

I am not a doctor nor do I play one on TV


http://slow-triathlete.blogspot.com/
Quote Reply
Re: Plica Syndrome and Cortisone [jonblyer] [ In reply to ]
Quote | Reply
I had a scope for medial plica in 1987 after suffering from sharp pain and a click on the downstroke of every pedal revolution for much of the cycling season. My doc had me go the pt route for several weeks, although no shots were administered, before doing the surgery in early November. After crutching for just a few days I felt relief straight away and was nordic ski racing 5 weeks later. Didn't pedal again until that spring (I'm a northern New York nordic geek) but never had even the slightest sensation from the plica again. I ride 2500 to 3500 miles per season, every season and run 15 or so miles a week from Labor Day til the snow flies. Despite ACL recon (patellar graft) on the same knee in 1997, it's still all good.

My feeling is if it comes down to having the scope, it's quick and painless as knee surgeries go and yields good pr better results. Good luck!

Mike......

Yeah, yeah,...first post!
Quote Reply
Re: Plica Syndrome and Cortisone [jonblyer] [ In reply to ]
Quote | Reply
How is the doc diagnose the plica? Generally its a thick band of tissue (knee lining)that connects between the femur (thigh bone) and patella (knee cap) and you can usually feel it with pressing on the knee in this area in a relatively pin point area of tenderness.If the plica has been there for a few weeks, then cortisone may work....if its been there for few months, then likely plica is not inflammatory but fibrotic, then cortisone less likely to help. I agree that the funny feeling in the knee will resolve 24-72hrs. If the cortisone is going to help it will help within the first 7-10 days or probably not at all....I would also probably take some antiinflammatories orally, use ice on this area after training, avoid kneeling during this time.. As far as training I would train light (running no hills, cycling no grinding) for maybe 2 weeks while meds see if there going to work,, if your getting better, then stay with lite training and then slowly inc. training as tolerated based on pain...if not better(or at least showing some signs of improvemetn) after 2 weeks then meds are not likely to help. Might then try some PT where they can instruct on a patellofemoral stretching program....If the plica continues to keep from training, then due to the mechanical nature of the plica tissue, removing the plica via arthroscopic surgery may be necessary...let me know if other question

Michael in Kansas
"Once you learn to quit, it becomes a habit"
"Its not whether you get knocked down, it's whether you get up" Lombardi
Quote Reply
Re: Plica Syndrome and Cortisone [rockchalk] [ In reply to ]
Quote | Reply
Thanks for all the infomation. I went up to Dr. Metzl's office this morning (he's the guy who writes in Triathlete). He basically listened to my story which dates back to August when I started feeling the pain on long runs (training for hawaii). The race was painful, I limped through sections of the marathon because of the knee. 4ish months later, I'm still aggrivated by it, and volume and intensity have been very low for the most part.
He sensed it by palpating the medial aspect of my knee, there were a few spots where he could definately feel something and I could definately feel the popping sensation that's been described. I guess I would call it a fiber, rather than just an irritation.
I'll keep the training light for the next few weeks and see what happens, thanks for the advice, it's greatly apprecaited!

Jonathan Blyer,
ACME Bicycle Co., Brooklyn, NY
Quote Reply
Re: Plica Syndrome and Cortisone [jonblyer] [ In reply to ]
Quote | Reply
Hi,
I have been experiencing knee pain on the medial side of both knees for nearly a year now. I am going to try to keep my story short - last November I suffered a bone bruise to the right knee. I had been running and cycling (mainly) at this time, although had increased my running probably too fast. The MRI showed a bone bruise. I did not do much of anything for 2 months. I finally started a PT program for chondromalacia b/c I was still having knee pain (had developed some in the left knee). Successfully completed the 4 weeks of PT, only biked during this time. Around mid-March I was not experiencing pain. I changed my bike fit at the end of the month and from there it has been a downhill slide. I kept trying to incorporate the PT exercises again, had another bike fit, finally got another MRI in July - everything looked perfect on the MRI, literally a "perfect" knee. Yet the pain persisted. Took 2 weeks completely off at the end of July and went to Europe with the fam - and then started with other forms of exercise - tennis, kickboxing, elliptical, gym stuff, a little running. I had been following a back to run program and was up to 3 miles.

During this time the pain was improving, but not gone. I got a second opinion from a sports doc in Dallas that was highly recommended. He felt confident it was plica syndrome and that my options were to wait and remove them arthoscopically when I had a break from school (am 27 in grad school), or to try this antiinflammatory cream and keep up with the other exercises (not only biking 250mi/week). Things were going pretty well, except 3 weeks ago I developed some SI joint inflammation and have not been able to play tennis or run, I feel the knee pain has gotten worse and honestly I am doubtful that it will improve with the conservative measures if it hasn't gotten better after the last 2 months of "normal" exercise.

I am going to see a 3rd sports doctor to get one more opinion, but I was wondering if you had success with the cortisone shot for plica syndrome. I am desperate to get rid of this and stop worrying about it, but I also hate to have surgery when I have read so many stories about people getting worse after this surgery than before.

I am not trying to run a marathon, but I am a very active girl, and in the past was able to run half-marathons, I played collegiate tennis, and spent the last 3 years racing bikes. Any information on this condition would be much appreciated! Thank you.
Quote Reply
Re: Plica Syndrome and Cortisone [evk78] [ In reply to ]
Quote | Reply
Hi, this goes way back at this point, but ultimately it was found not to be a plica that I was suffering pain from but a nerve injury that was causing pain in the knee. It took about two frustrating years and a non necessary surgery to figure this out unfortunately, I hope your recovery comes quicker..

From what I understand, the nerve injury is rare but it is worth ruling out on your part. I had an entrapped saphenous nerve which Google can tell you all about.

Jonathan Blyer,
ACME Bicycle Co., Brooklyn, NY
Quote Reply
Re: Plica Syndrome and Cortisone [evk78] [ In reply to ]
Quote | Reply
My suspected plica syndrome was a pulled VMO or Sartorious muscle (they still don't know which). I'd be damn sure before they cut you open that PS is your real diagnosis.
Quote Reply
Re: Plica Syndrome and Cortisone [JimMoss] [ In reply to ]
Quote | Reply
Thanks for the replies. yes, I would definitely get a third opinion before going in for surgery. I have researched several sport medicine knee experts in the area (austin, tx) and have found one I am going to make an appointment with. But I am going to wait until I have a bit more data (waiting for the SI inflammation to clear and will add back the tennis and running so that I have a feel for what is creating pain) before I go in for the appointment.

Its strange I went my entire life without having one injury until 2 years ago, now it seems I am constantly fighting various injuries, and I used to never consider all these different "preventative" things, I just went out and did what I wanted...sigh. But from everything I can gather, the only option is plica syndrome, it's visible on MRI, but doesn't look irritated, although other doctors said that visible plica's can be asymptomatic or symptomatic with no clear definitive association with appearance on MRI.
Quote Reply