Bilateral Patella Cartilage Debridement and Exercise Rehabilitation for Chondromalacia and Plica Syndrome: A Case Report

Jihong Park,Jin Goo Kim ,Bongseong Ko

doi:10.3390/app11094078

Jihong Park, Jin Goo Kim + Show 1 more

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https://doi.org/10.3390/app11094078

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Abstract

A 41-year-old active (exercising >600 min per week) male without a surgical history complained of nine years of intermittent bilateral anterior knee pain after physical activity. He was diagnosed with bilateral chondromalacia (grade IV chondrosis) with plica syndrome, for which he underwent bilateral patella cartilage debridement with medial plica excision (additional removal of lateral retinaculum in the right knee). The patient then performed 12 weeks of an aggressive postoperative rehabilitation program. Each rehabilitation session consisted of disinhibitory modalities (sensory level of transcutaneous electrical stimulation and cryotherapy: focal knee joint cooling and cold-water immersion) and voluntary exercises (aerobic, resistance, and flexibility). During rehabilitation, pain perception, knee joint skin temperature and circumference, and functional outcome measures (Kujala anterior knee pain scale, International Knee Documentation Committee Score, and lower-extremity functional scale) were also recorded. While the patient’s pathology and surgical intervention were not extreme, progressions in the rehabilitation components and functional outcome measures in this clinical case could be used as a future reference for postoperative interventions. Additionally, surgery-induced inflammation seemed to last for four weeks.

Highlights

Chondromalacia is defined as softening and destruction of the patellar cartilage that can be caused either by overuse, retinacular tightness, abnormal patellar positioning, abnormal Q-angle, quadriceps weakness or imbalance, or in combination
Plica syndrome is a condition in which synovial plica within the joint capsule at the patellofemoral joint becomes irritated, inflamed, and thickened [3]
We present a case of chondromalacia with medial plica syndrome in a patient who underwent bilateral arthroscopy followed by an aggressive postoperative rehabilitation program

Summary

Introduction

Chondromalacia is defined as softening and destruction of the patellar cartilage that can be caused either by overuse (microtrauma), retinacular tightness, abnormal patellar positioning, abnormal Q-angle, quadriceps weakness or imbalance, or in combination [1,2]. Plica syndrome is a condition in which synovial plica within the joint capsule at the patellofemoral joint becomes irritated, inflamed, and thickened [3]. Nonsurgical treatment is first attempted for both pathologies, and symptom relief along with strengthening of the quadriceps and other lower-extremity muscles are the main course of conservative treatment [5]. We present a case of chondromalacia with medial plica syndrome in a patient who underwent bilateral arthroscopy followed by an aggressive postoperative rehabilitation program

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