Plica Syndrome / Patello-Femoral Syndrome?

Originally posted by Alan Jeddeloh
I've been bothered by a soreness in my left knee since mid November. It came on suddenly, and at
first I though I had just strained a tendon. It petty much limited my riding until the first of the
year. At that point I got back into intermittent commuting and weekend rides of 15-20 miles.

The soreness started coming back and I went to the doctor a few weeks ago. The doctor examined the
knee, concluded there was nothing structurally wrong, other than chronic inflammation or tendonitis.
He put me on a prescription NSAID for a week and told me to stay off the bike for that time to give
it a chance to get thoroughly quieted down. After I again rode to work, did a brief run for lunch,
and rode home -- 18 miles net for the day. My knee again acted up coming home, becoming downright
painful pulling the last hill.

I returned to the doctor the next day, different Doctor* again examined the knee and concluded there
was nothing structurally wrong, gave me some Celebrex samples and a referral to a PT.

I saw the PT the following day, who made her own evaluation (nothing structurally wrong with the
knee) BUT: my kneecaps are sitting to the outside a bit. Her supposition was that I either have
Patello-Femoral Syndrome (Patella not tracking properly causing irritation, or Plica Syndrome, where
the medial Plica** is inflamed. For both she gave me a set of stretching exercises (Hamstrings,
Quads, Iliotibular band, plus a stretch for the kneecap itself. She also assigned me to get another
bike fitting.

I did the fitting, then tried a ride. At about 8 miles my knee served notice that if I didn't stop
soon it was going to make my life miserable. I reported my status to the PT the next day. This time
she deep-massaged the knee in the area of the medial Plica and found a nice big bump. I came home
with some more exercises and stretches.

I spent some time on the web researching Patello-Femoral Syndrome and Plica Syndrome. Between the PT
visit and various web sites, it seems like the Plica is the most likely culprit. The depressing news
is that it looks like the "conservative" course of treatment runs 6-12 weeks and only works in about
40-50% of cases. During that time you have to give up the aggravating activities (cycling, in this
case). The next option appears to be arthroscopic surgery to remove the Plica.

Has anybody had experiences with Plica Syndrome? How did it turn out? How long did it take you to
get back on the bike.
--
Alan Jeddeloh "ajeddelo at easystreet dot com" The person who said "The only things certain in life
are death and taxes" didn't do the laundry in a family with children!

* Same practice, I usually get the doctor on call. ** The Medial Plica is simply a fold of spare
tissue on the synovial sac.

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Originally posted by Dave Cook
Soccer players have a similar problem to the imbalance you describe. They will often use "pre-wrap"
just below the knee which puts slight pressure low on the patella keeping it in its track. There is
also a device - a kind of strap - sorry, I forget the name - that accomplishes the same thing. Maybe
Alan could run this past the therapist. It also makes a big difference if the therapist is a
cyclist. Good luck Alan. "S. Anderson" <[email protected]> wrote in message
news:[email protected]...
> I'm not a doctor and I'm not there, but here's a tidbit for you to
consider.
> I know that if you're predominantly a distance rider, you can develop an imbalance in your quad
> muscles to the point that the outer quads overpower the inner muscles and you end up pulling the
> kneecap to the outside of its track. The person I know that had this problem had weight-lifting
exercises
> prescribed that would strengthen the inner quads, much like a sprinter
would
> do. This alleviated the problem and it has never recurred, AFAIK.
Anyway,
> if they're pulling you off the bike anyway, you might want to do some
squats
> designed to work the inner thighs and you might have some relief from
that.
>
> Cheers,
>
> Scott..
> --
> Scott Anderson
>
>
> "Alan Jeddeloh" <[email protected]> wrote in message
> news:BA90E7DB.1AD2%[email protected]...
> > I've been bothered by a soreness in my left knee since mid November. It
> came
> > on suddenly, and at first I though I had just strained a tendon. It
petty
> > much limited my riding until the first of the year. At that point I got
> back
> > into intermittent commuting and weekend rides of 15-20 miles.
> >
> > The soreness started coming back and I went to the doctor a few weeks
ago.
> > The doctor examined the knee, concluded there was nothing structurally wrong, other than chronic
> > inflammation or tendonitis. He put me on a prescription NSAID for a week and told me to stay off
> > the bike for that
> time
> > to give it a chance to get thoroughly quieted down. After I again rode
to
> > work, did a brief run for lunch, and rode home -- 18 miles net for the
> day.
> > My knee again acted up coming home, becoming downright painful pulling
the
> > last hill.
> >
> > I returned to the doctor the next day, different Doctor* again examined
> the
> > knee and concluded there was nothing structurally wrong, gave me some Celebrex samples and a
> > referral to a PT.
> >
> > I saw the PT the following day, who made her own evaluation (nothing structurally wrong with the
> > knee) BUT: my kneecaps are sitting to the outside a bit. Her supposition was that I either have
> > Patello-Femoral Syndrome (Patella not tracking properly causing irritation, or Plica Syndrome,
> > where the medial Plica** is inflamed. For both she gave me a
set
> > of stretching exercises (Hamstrings, Quads, Iliotibular band, plus a
> stretch
> > for the kneecap itself. She also assigned me to get another bike
fitting.
> >
> > I did the fitting, then tried a ride. At about 8 miles my knee served
> notice
> > that if I didn't stop soon it was going to make my life miserable. I reported my status to the
> > PT the next day. This time she deep-massaged
the
> > knee in the area of the medial Plica and found a nice big bump. I came
> home
> > with some more exercises and stretches.
> >
> > I spent some time on the web researching Patello-Femoral Syndrome and
> Plica
> > Syndrome. Between the PT visit and various web sites, it seems like the Plica is the most likely
> > culprit. The depressing news is that it looks
> like
> > the "conservative" course of treatment runs 6-12 weeks and only works in about 40-50% of cases.
> > During that time you have to give up the
> aggravating
> > activities (cycling, in this case). The next option appears to be arthroscopic surgery to remove
> > the Plica.
> >
> > Has anybody had experiences with Plica Syndrome? How did it turn out?
How
> > long did it take you to get back on the bike.
> > --
> > Alan Jeddeloh "ajeddelo at easystreet dot com" The person who said "The only things certain in
> > life are death and
> taxes"
> > didn't do the laundry in a family with children!
> >
> > * Same practice, I usually get the doctor on call. ** The Medial Plica is simply a fold of spare
> > tissue on the synovial




sa
> I have similar conditions to discuss. Please write me

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