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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.
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What
to ask the doctor
What
to take to the hospital
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.
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ABC’s
of anesthesia
What
to take to the hospital
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.
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.
Arthroscopic
excision is outpatient surgery, and does not require
an overnight stay in the hospital or clinic.
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.
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Recovery-proof
your home
When
to call the doctor after surgery
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.
Prevention
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.
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