In this week’s Ask Dr. Geier column, I discuss a diagnosis that really had fallen out of favor in recent years but occasionally returns. As always, please refer to my disclaimer about me discussing specific medical information online or by email.
What has been your experience with recovery after surgery to treat plica syndrome in terms of the patient getting back into playing shape? Especially in volleyball players?
There are two main points that I think are worth mentioning about plica syndrome to answer this question. First, surgery specifically to treat a painful plica is fairly unusual. It used to be done very frequently as a reason to perform arthroscopic surgery on the knees of athletic people, but sports medicine surgeons started to realize that these plicae were rarely the source of an athlete’s pain.
A plica is a band or fold of tissue within the knee. As embryos or fetuses, plicae of the knee are fairly common, and as humans age, they often go away. A significant percentage of people, however, do have plicae that remain within the knee. The problem is that the vast majority of people with plicae rarely have problems from them. Surgery to scope the knee and remove them would result in a huge number of unnecessary surgeries.
Often people with plicae that actually are symptomatic can still be treated without surgery. Rest, icing the knee, anti-inflammatory medications, and occasionally injection of small amounts of a steroid such as cortisone into the plica itself can relieve the symptoms. Occasionally athletes do not get better with these treatments. If the patient’s history, physical exam, and radiographic studies (such as an MRI) suggest the presence of a plica, particularly if it is swollen on the imaging, surgery can be attempted.
Fortunately, surgery to excise a painful or symptomatic plica, such as one that causes a clicking sensation on the inside of the knee, can be very successful. The surgery involves looking in the knee arthroscopically and using a shaver to remove this band of tissue. Usually it is a fairly quick recovery. The surgery takes 15 to 20 minutes, and the athlete is allowed to bear weight almost immediately. The first 10 to 14 days involve efforts to decrease swelling and regain range of motion and strength. Usually an athletic individual returns to exercise within days or one to two weeks. Usually return to full sports takes only three to six weeks, although full recovery often takes several months. The success rate for returning to sports at the same or higher level is usually very good, again assuming that the plica was the source of the pain.
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