Knee > Plica Syndrome > Treatments

   Arthroscopic Excision

Preparing for Surgery

If non-surgical treatments for your plica syndrome have proved ineffective, your physician may suggest an arthroscopic excision, in which the plica is removed through a short procedure using instruments inserted through a small incision in your knee. The decisions you make and the actions you take before your surgery can be every bit as important as the procedure itself in ensuring a healthy recovery. Most insurance companies require a second opinion before agreeing to reimburse a patient for a surgical procedure. Getting a second opinion from a surgeon who is as qualified as the surgeon who gave the initial diagnosis is advisable in any case.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include a knee brace, crutches, ice packs or coolers, or a continuous passive motion (CPM) machine. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Understand the potential risks and benefits of the surgery, and ask your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   If possible, practice walking with your crutches in case you need to use them after surgery.

   Make sure the orthopedist performing the surgery is board-certified, which can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.


   What to ask the doctor

   What to take to the hospital

Day of Surgery [top]

At most medical centers, you will go to "patient admissions" to check in for your arthroscopic excision. If your surgery is going to be inpatient, there may be a separate department, so be sure to ask your doctor. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your knee area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or nurse anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia, which can lead to pneumonia.

   Since you will most likely be able to go home within a few hours of surgery, and because the anesthetic and pain medications may make you drowsy, arrange for someone to drive you home when you are released.

   Wear a loose pair of pants or other clothing that will fit comfortably over your knee bandage when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.


   ABC’s of anesthesia

   What to take to the hospital

Surgery Procedure [top]

Arthroscopic excision normally takes about between 20 and 40 minutes to perform, and usually you will be able to leave the hospital the same day.

   General anesthesia is typically used for this type of surgery, though in some cases a spinal or epidural anesthetic is used. The anesthesiologist will administer the anesthesia once you are in the operating room.

   The arthroscope is inserted into the knee through a small incision. Fluid is injected into the joint through the same incision, which allows the surgeon to view the plica and check to see if there is any other damage to the joint.

   One or two additional small incisions are made to allow the insertion of instruments into the knee, and the plica tissue is removed.

   Incisions usually are closed with stitches and the patient is taken to the recovery room.

Recovery Room [top]

After your arthroscopic excision, you will remain in the recovery room until you have recovered from the effects of anesthesia, which may include drowsiness. Many surgeons inject local anesthesia into the knee in the operating room, which helps to numb some of the tissues surrounding the knee and decreases pain for two to eight hours. If this was done, you may not need pain medicine until you go home. Your knee will be bandaged and wrapped, usually with an Ace-type bandage wrapped over layers of gauze and cotton, and your knee will be elevated. Ice may be used to reduce swelling, and a brace may be used to keep the knee stabilized. Your surgeon may suggest you use crutches or a cane initially, though you probably will be able to bear some weight on the leg right after surgery. Your temperature, blood pressure, and heartbeat will be monitored by a nurse who, with the assistance of the doctor, will determine when you can prepare to go home. You will normally be able to leave the hospital or clinic within a few hours after surgery. Make sure to have someone available to drive you home, as you will most likely be unable to drive a car.

Post-op in Hospital  

Arthroscopic excision is outpatient surgery, and does not require an overnight stay in the hospital or clinic.

Home Recovery [top]

Most patients are able to return to work within a few days after arthroscopic excision, provided work does not involve strenuous activity such as heavy lifting or climbing. You may need to use crutches during the first week, though you also may be able to bear weight on your leg. It may take a week or more before you can resume driving a car, depending on which leg was operated on and the type of car you drive. The wrap usually can be removed from the knee within 12 to 72 hours after surgery. Some bruising or swelling is normal, and you will notice a few small incisions held together by tiny stitches. Icing your knee three or more times a day for 15 to 20 minutes at a time, and elevating it above heart level, can decrease pain and swelling. Taking non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen also can reduce pain and inflammation. The first follow-up visit is usually scheduled for a week to three weeks after surgery, at which time the stitches will be removed.


   Recovery-proof your home

   When to call the doctor after surgery

Rehabilitation [top]

The most important component of rehabilitation for sufferers of plica syndrome is relative rest. This means modifying your workouts to avoid the activities that cause pain. For example, instead of riding a bike or running, you could swim or rollerblade instead. Or, if your pain is not severe, you could reduce the intensity of your workout ­ for example, using less resistance when you ride, or eliminating hills from a running workout. Depending on how serious you are about the relative rest and physical therapy, you may be able to return to a normal level of activity in six to 12 weeks. You may be able to return sooner, but you may experience pain while engaged in physical activities, and it may set back your rehabilitation. The pain is usually felt during exercises, but can be even worse afterwards.


While it is always important to stretch and strengthen the muscles around your knees, particularly the quadriceps and hamstrings, these will not by themselves prevent plica syndrome, which is primarily caused by overuse. However, you may be able to reduce your chances of recurring plica syndrome by avoiding a sudden increase in activities that require repetitive motion that irritate the plicae, such as cycling or using a stair-climbing machine, and instead, easing into a routine.

Rest and Ice
Non-Steroidal Anti-Inflammatory Drugs
Therapeutic Injection
Arthroscopic Excision
   Preparing for Surgery
   Day of Surgery
   Surgery Procedure
   Recovery Room
   Post-op in Hospital
   Home Recovery

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