Therapy
Often a conservative therapy is sufficient. This is particularly true in the case of plica syndromes, where there is still enough space in the joint space and no cartilage degeneration has occurred. In any case, conservative treatment includes the reduction of stressful movements.
Excessive sport should be reduced or avoided altogether, and movements that place a particularly heavy strain on the knee joint (climbing stairs, mountain hiking) should be reduced. The knee should be cooled regularly. In addition, anti-inflammatory drugs such as ibuprofen or diclofenac can be used.
If these measures are not sufficient, an arthroscopic removal of the plica is a surgical measure that can be performed. In the ideal case, the plica can be ablated and removed from the joint space during diagnostic treatment using the instruments already inserted. Conservative measures also include physiotherapeutic treatment, which should always be continued, even after surgery. During this physiotherapy, the muscles surrounding the knee joint are trained, thus protecting the knee joint. Physiotherapy should be carried out consistently and regularly over several weeks.
Who needs an operation?
First of all, it can be said that not every plica necessarily requires therapy. It is estimated that approximately one in two knee joints has such an intra-articular fold. But by no means every person has complaints about this.
The plica only becomes a nuisance when a heavy load on the knee joint, such as frequent squatting or cycling, leads to pain in the joint. In this case, therapy should be initiated to relieve the symptoms. Surgery is only considered if conservative treatment methods have failed and there is still a lot of pain or the knee is severely inflamed.
Conservative measures include protection and cooling of the inflamed joint, physiotherapy, a supply of suitable insoles for the shoes, anti-inflammatory drugs or pain medicine or joint injections with the anti-inflammatory cortisone. Even if the non-surgical therapies have previously failed, there is an extremely high probability of recovery through surgery. However, it must be remembered that pain may still be present after the operation if cartilage damage has already been caused by Plica Syndrome.
This is not remedied by the minimally invasive surgery. In addition, patients who are active in sports are more likely to opt for the operation, as it is unlikely that conservative measures will be able to alleviate the symptoms in the long term if the knee joint is subjected to constant sporting activity. The operation for plica syndrome is performed arthroscopically.
This means that the knee is not opened completely via a long skin incision, but only a camera and a surgical tool are inserted into the joint in the working channel via two much smaller lateral incisions. Controlled by the camera, the disturbing inner joint skin (plica) can then be removed through the working channel. The procedure usually takes no longer than 15 minutes and is usually performed on an outpatient basis with local anesthesia.
After the operation, drains usually remain in the operating area for about two days. In addition, walking aids are required for the initial period, as the knee must not be fully loaded. In addition, anti-inflammatory medication is prescribed as long as signs of inflammation are still visible.
Depending on the need, physiotherapy should be taken during the post-operative period to strengthen the thigh muscles that span the knee. Furthermore, electrotherapy can also be used to stimulate the muscle. During sports, it is important to ensure that uniform movements, such as cycling, are possible again as soon as the knee can be bent enough.
Sports with many start-stop movements, such as tennis or soccer, on the other hand, should be avoided until the knee is free of inflammation and has healed. How long after the operation crutches must be used depends on the recovery. In general, walking aids should be used as long as the joint is still irritated.
It may appear to heal after two to three days, but it may also take two to three weeks before the crutches can be dispensed with. In general, the extensor muscles of the thigh should already be trained directly after the operation.A complete relief would be counterproductive and prolong the healing process. However, overloading should of course also be avoided.
How long one is unable to work after the operation depends on various factors. Firstly, a generally good overall physical constitution of the patient leads to a faster healing process. Furthermore, the patient’s cooperation plays an important role.
If the necessary exercises for muscle building are not performed after the operation, this has a negative effect on the recovery and prolongs it. Once the knee has healed completely, no damage is left behind and full weight bearing is possible again. As a rule, work can therefore be resumed after about one to four weeks.
Sport is only fully possible again after about four to six weeks. Physiotherapeutic treatment should be started immediately after the operation. The aim of the treatment is to strengthen the muscles surrounding the knee joint, so that the joint becomes more resilient.
The exercises can be performed primarily using the patient’s own body weight or with the help of training bands. It is also important to train the trunk muscles, as this contributes to the stability of the leg. The gait training can initially consist of slow uphill gaits on a treadmill.
In the course of the training, jumping training should be introduced, which prepares for jogging in the last step. A certain jumping ability is necessary for jogging, because with each step both feet leave the ground briefly. In addition, it should be checked whether there is a muscular imbalance between the extensor and flexor muscles of the knee.
If this is the case, this should be corrected by strengthening the weaker muscles in a targeted manner to reduce the pressure on the kneecap. An imbalance between the muscles of the thigh pulling outwards and the muscles pulling inwards also has a negative effect on the plica syndrome, as the patella is pulled out of the center line and thus incorrectly loaded. Furthermore, a regular stretching of the knee joint muscles can also be helpful.
