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Knee arthroscopy - post op pain!

Mar 26, 2010
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I need advice regarding an arthroscopy l had last year to repair a medial meniscus tear and a plica (Hoffa’s fat pad) resection. I’m 26 years old, and prior to the operation, l was training around 150 miles a week, participating at 3rd/4th cat races and weekly time trials.

The problem began when riding home from work in August - l developed a pain below my kneecap (right leg), which turned out to be tendonitis. This settled down, only for a lingering pain underneath the kneecap to remain. I visited a local knee surgeon, who suggested surgery due to a lack of success with physiotherapy treatment, and an MRI scan that displayed thickening and tethering of the fat pad and a small tear in the medial meniscus. Up until this point l had not felt any pain in the meniscus, however the surgeon suggested a repair before it became a problem. The operation was successful, with a sizeable section removed from the plica, and the tear sewn up.

I received physiotherapy for around three months, and was able to get back on the bike without difficulty around January time. Any soreness that developed would fade after a few hours, and l was able to ride without discomfort. I would regularly ice the knee to address swelling, and my physio administered ultrasound and acupuncture to deal with the scar tissue

My problems began when l went out for my first ride with a group, and l have to admit went too quickly. My knee became painful, with a painful ache around the plica, and acute pain along the joint line where the meniscus was repaired. The pain has improved slightly since the ride, however l am left with a lingering painful ache both underneath the arthroscopy portals and kneecap itself (medial side), and acute soreness along the meniscus repair. I am working to keep my muscle bulk in my thighs, however squatting produces a painful sensation underneath my kneecap, and any massage around the meniscal area tends to produce a catching sensation, almost as if l am pulling on the stitches. I carried on going to see my physiotherapist, however after it was clear the treatment was not adequate, referred me back to the surgeon, who arranged another MRI.

I have recently received the MRI results, which state that the scan was clear, with nothing to suggest that there is any problem with my knee. My left knee has also developed similar symptoms over the past few weeks, with an aching sensation underneath the kneecap. As you can imagine, this has proved somewhat frustrating.

I am continuing with my exercises to strengthen my quads and calves, however this tends to leave me in more pain than pre-exercise. I am currently waiting to see the surgeon again, and will be asking him about a possible cortisone injection into the plica, as I believe this is my only remaining option.

Could you tell me if there are any other possibilities, or if you have come across such a case before? Although l am desperate to get back on the bike, l would like to live pain free first!

Many thanks
Jul 14, 2009
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sorry to hear about your grief. You need to get a into therapy that can cross train your knee.If the exercise/range of motion on the bike is hurting you may need to do a series of other exercises that stretch and strengthen the surrounding muscles. You may have to stay off your bike in order to rehab your knee the right way. If you do not have that many miles on your leg and your bike position, you may want to get a tape measure and document all your bike settings.Seat height,seat position behind the bob,distance of the bars from the saddle,real top tube distance. Sometimes knee pain can be caused by shoes or seat height. The reason you want to have everything written down is so you don't make so many changes and can't get back to your original position,also you may want to disable your front deraileur so that there is no way for you to push a big gear,you may be pushing a harder gear than your body can take at this early stage. The way you find out you shouldn't be in the big ring is when you reblow out your knee, avoid the problem by eliminating the option. Also group rides can be a death nail when you are trying to recover,you will keep up with other people only to find out you pushed your knee way too hard. There is no simple or fast way to do it
Knee Pain

You may have a muscle imbalance after the surgery. A common effect after surgery is the lateral quadriceps and Iliotibial Band are dominant over the vastus medialis. You may also have some associated gluteus medius weakness which is creating the TFL muscle which attaches to the ITB to be very tight.
Cross friction massage may also help over the irritated area.

One treatment that can be effective is trigger point dry needling which releases the compression that is created by the trigger points.
Trigger point dry needling is not acupuncture.
Here is a good link


One question is if the plica was removed why do another surgery?
Plicas can grow back, but probably not that quick.

If you have a new bike and or cleats, think about a bike fit.

Hope that helps
Mar 26, 2010
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Hi there-
I am a little confused by your post since you mention hoffa's fat pad and plica as synonyms, when they are different structures (but perhaps you meant both the plica and part of fat pad was removed?)

plica- fold in synovial lining of joint, inside kneecap (there are several plicas, medial plica is most commonly the troublesome plica). Fat pad-- structure below patella near patellar tendon

This is not rocket science, but it sounds as though you overdid it and now have a very aggravated knee! I agree with the comments above re strengthening and perhaps staying away from group rides til you are 100%.

In addition, some of your current symptoms are quite similar to symptoms that I had for months (many months) following plica removal/lateral meniscectomy last fall. Here's what helped for me:

-have hip/leg alignment checked by PT/chiro (mine was messed up, causing weird angles/pressures at the bad knee while walking/riding/lifting, which was quite irritating to the knee. This has been fixed and has made a HUGE difference on the knee swelling & pain)

-switch PTs? Perhaps a new perspective is in order. (I switched PTs after ages with little progress, and the first thing the new PT noticed was my pelvic alignment issue (and that I had been working the knee too hard, both in prior PT and on the bike). New PTs approach has made an incredible difference in my rehab. Perhaps you would benefit from a fresh persepective, if you have the option to try someone else.)

-back off on activity to let the knee cool off. Never do anything that results in pain. consider consulting pt again to get advice on knee-safe exercises or to make sure you are doing exercises/lifting with perfect, knee friendly form (I backed off for about 5 weeks while continuing to do some stuff to maintain strength and flexibility. it REALLY helped)

-have bike fit checked, consider having bike alterations made to be more knee friendly until you recover (eg, shorter cranks, lower gears, cleat adjustments). You want to be well aligned on the bike.

-try a different anti-inflammatory (or start one if you are not using one already)?

-massage for scar tissue issues. I had/have adhesions around the portals and plica site and near ITB. Deep tissue massage has helped a lot. Sounds like you've had some work done on scar tissue already. May be worth having it looked at again, especially around the fat pad.

One more thing: not to make you paranoid, but MRIs are notorious for not revealing meniscus problems. I had severe joint line pain prior to my meniscectomy (resolved with the surgery), I wonder whether you've reinjured the meniscus and it is just not showing up on your scan?

Also, it's not uncommon for the "good" knee to start getting cranky after a while, due to compensation for the bad knee.
Good luck sorting it out. Chronic injury sucks.