A painful plica mediopatellaris or synovial fold next to the knee cap is noticeable when there is pain in the front inner side next to the kneecap, blockages, or a feeling of swelling in the knee joint.
Detailed questioning often gives rise to the suspicion that you may have a painful plica. A history of bruising of the knee joint is common. The thorough physical ex- amination usually shows typical signs. X-ray images show whether and to what extent a beginning wear and tear or osteoarthritis plays a role. The plica cannot always be seen in the MRI.
1 – A large mediopatellar plica is shown in the axial MRI image of the right knee.
If there are clear signs of a painful plica, it is always worthwhile to first approach the situation with physiotherapy. If complaints persist, we will suggest an arthroscopy of your knee joint.
Under general or regional anesthesia, three short incisions of approximately 1 cm in length are made on the front of your knee in order to be able to introduce irrigation fluid and the instruments into your joint. Thanks to a slim lens with a camera, we can see the joint structures on the screen, and thus have all of our surgical steps under control. If you wish, you can follow the operation on the screen. Duration of the operation: about 30 minutes.
A plica is known to be made of quite delicate tissue. We also know from experience that the knee joint can be somewhat sensitive and swollen for a long period of time after this operation.
2 – Arthroscopic view of a large plica mediopatellaris on the right knee
3 – Arthroscopic view of the right knee after removal of the plica
You will be treated by experienced surgeons. And yet it is like flying: no surgery is without risk. The risks of this operation can be summarized as follows:
- Risk of infection: less than 1%
- Probability that you will require a blood transfusion: ~ 0%
- Damage relevant blood vessels: less than 1%
- Damage to relevant nerves: less than 1%
- Thrombosis/Embolism: ~ 1%
- The knee may be swollen for a few weeks after this
After an arthroscopy for plica removal, you will stay in the hospital for 2 nights. The day after the operation, the drain will be removed from your knee and the swelling and wounds will be checked. You should be able to put your full weight on it, but it is advisable to take good care of yourself and your knee for a few days, i.e. use crutches for a week or two.
You will go home when you are practically pain-free, moving well on your crutches and have your knee and the entire situation under control. You will leave the clinic with a prescription for physiotherapy, the necessary medication for swelling, pain relief and thrombosis prophylaxis as well as a check-up date in our out-patient clinic. Your family doctor will remove the stitches about 10 – 14 days after the operation; in most cases, after the 6 week check-up, the surgical side effects have subsided.