DESCRIPTION

A plica is a synovial fold. Four different plicae can exist in the knee: suprapatella, infrapatella, medial and (rare) lateral. Plicae can occasionally become inflamed following direct trauma or secondary to some other irritation, this may cause thickening and symptoms such as pain and catching. If they don’t settle with conservative measures they can easily be removed by arthroscopy.

ACUTE STAGE (Immediately post-op)

Elevation of the limb when resting
Muscle pump exercises
Isometric quadriceps
Flexion within pain free range
F.W.B.

SEVEN DAYS

Check wounds
Vastus Medialis exercises
Progressive mobilising & strengthening exercises eg,

·         Static bike

·         Climber

Knee flexion - N.B. heel to buttock contact should be achieved by 21 days post-op to avoid formation of adhesions

 

CONDITIONS FOR DISCHARGE

 Discharge is usually between three to six weeks post-op.

1) No swelling or pain
2) Full R.O.M.
3) Normal function for the individual patient
4) Patient is aware of importance of continuing exercises.

ACUTE STAGE

Elevation of the limb when resting
P.W.B. / F.W.B.
Isometric exercises
Muscle pump exercises
Gentle flexion (within pain free limits)

SEVEN DAYS

Check wounds
Vastus Medialis exercises
Progressive mobilising and strengthening exercises eg, static bike, dips,
(bilat à unilat), step ups, stair climber, knee flexion etc.

 

CONDITIONS FOR DISCHARGE

Discharge is usually between three to six weeks post-op.

1) No swelling
2) Full R.O.M.
3) Normal function for the individual patient
4) Patient is aware of the importance of continuing exercises

These techniques are designed to affect a degenerating joint surface by stimulating regeneration of fibrocartilage.

·         It is vital that the affected area is not over-loaded whilst this recovery takes place (anything from six weeks to six months).

·         The tibio-femoral joint should be protected by a period of minimal weight-bearing (as dictated by the surgeon), followed by a period of gradually increasing partial weight bearing.

·         The patello-femoral joint should avoid loading (ie. flexion beyond 20’ in a weight bearing situation) by squatting, stairs or open kinetic chain activities with weights.

·         The joints respond well to movement, such as static cycling, as there are low joint compression forces. Patients may be advised to have a CPM machine at home for 4 -6 weeks

·         Occasionally braces may be used to help the patient adhere to the necessary protocol.

·         Patients should be advised that rehabilitation can be a lengthy process as intra-articular healing takes time.