Post-op plica excision pain
Hi,
I need advice regarding an arthroscopy l had last year to repair a medial meniscus tear and a plica (Hoffa’s fat pad) resection. I’m 26 years old, and prior to the operation, l was cycling around 150-200 miles a week, participating at 3rd/4th cat races and weekly time trials.
The problem began when riding home from work in August - l developed a pain below my kneecap (right leg), which turned out to be tendonitis. This settled down, only for a lingering pain underneath the kneecap to remain. I visited a local knee surgeon, who suggested surgery due to a lack of success with physiotherapy treatment, and an MRI scan that displayed thickening and tethering of the fat pad and a small tear in the medial meniscus. Up until this point l had not felt any pain in the meniscus, however the surgeon suggested a repair before it became a problem. The operation was successful, with a sizeable section removed from the plica, and the tear sewn up.
I received physiotherapy for around three months, and was able to get back on the bike without difficulty around January time. Any soreness that developed would fade after a few hours, and l was able to ride without discomfort. I would regularly ice the knee to address swelling, and my physio administered ultrasound and acupuncture to deal with the scar tissue
My problems began when l went out for my first ride with a group, and l have to admit went too quickly. My knee became painful, with a painful ache around the plica, and acute pain along the joint line where the meniscus was repaired. The pain has improved slightly since the ride, however l am left with a lingering painful ache both underneath the arthroscopy portals and kneecap itself (medial side), and acute soreness along the meniscus repair. I am working to keep my muscle bulk in my thighs, however squatting produces a painful sensation underneath my kneecap, and any massage around the meniscal area tends to produce a catching sensation, almost as if l am pulling on the stitches. I carried on going to see my physiotherapist, however after it was clear the treatment was not adequate, referred me back to the surgeon, who arranged another MRI.
I have recently received the MRI results, which state that the scan was clear, with nothing to suggest that there is any problem with my knee. My left knee has also developed similar symptoms over the past few weeks, with an aching sensation underneath the kneecap and occasional medial joint line pain. As you can imagine, this has proved somewhat frustrating.
I am continuing with my exercises to strengthen my quads and calves, however this tends to leave me in more pain than pre-exercise. I am currently waiting to see the surgeon again, and will be asking him about a possible cortisone injection into the plica, as I believe this is my only remaining option.
Could you tell me if there are any other possibilities, or if you have come across such a case before? Although l am desperate to get back on the bike, l would like to live pain free first!
Many thanks,
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