Plica surgery, formally known as arthroscopic plica excision, is a minimally invasive procedure performed to remove a thickened or inflamed synovial fold within the knee joint. The plica is a remnant of tissue left over from knee development. When irritated, often due to overuse or injury, it can cause chronic knee pain, clicking, or locking. The goal of the arthroscopic procedure is to excise the problematic tissue, relieving the mechanical irritation and pain it causes. Recovery depends on the extent of the plica’s involvement and how the knee joint responds.
The Initial Recovery Phase
The immediate post-operative period focuses on controlling swelling and pain to prevent stiffness and allow for early movement. Patients are typically discharged the same day, having received a local anesthetic injection that manages discomfort for several hours. Elevation of the surgical leg above heart level and consistent application of ice packs (15 to 20 minutes multiple times a day) are recommended. This adherence to the RICE (Rest, Ice, Compression, Elevation) principle minimizes the inflammatory response.
Crutches are initially needed due to post-operative pain and swelling. Although the surgery is minimally invasive, the joint needs protection during the first few days. Most surgeons allow patients to bear weight on the operative leg immediately (“weight-bearing as tolerated”). Crutches primarily assist with balance and offload weight when walking causes discomfort or a noticeable limp.
Early exercises, such as ankle pumps, quadriceps sets, and gentle heel slides, are often initiated within the first 24 hours to maintain muscle activation and range of motion. These exercises prevent blood clots and combat the reflex inhibition of the quadriceps muscle that commonly follows knee surgery. Activating the quadriceps is a foundational step that precedes the full discontinuation of walking aids.
The Crutch Use Timeline
The typical duration for using crutches following a straightforward plica excision is short, often ranging from a few days to about two weeks. This timeline depends on the individual’s pain level and achievement of specific strength and mobility milestones. Rehabilitation protocols often recommend using crutches with weight-bearing as tolerated for the first one to two weeks. Crutches serve as a temporary aid to ensure a safe, non-limping gait while initial swelling subsides and strength returns.
Progression off the crutches moves from using two crutches to one, then potentially to a cane, before walking unassisted. This transition is guided by the surgeon and physical therapist, who monitor the patient’s gait and muscle control. The primary criterion for discontinuing crutch use is the ability to walk without a painful limp, indicating the knee is stable and strong enough to support the body’s weight.
The specific milestone dictating the end of crutch use is the successful performance of a straight leg raise without extensor lag. Extensor lag occurs when the quadriceps muscle cannot contract strongly enough to lift the leg straight off the ground, causing the knee to bend slightly. Achieving this strength indicates sufficient quadriceps control to safely manage full weight-bearing. Once a patient demonstrates proper quadriceps activation and walks with a symmetrical, pain-free gait, the crutches can be put aside.
Transitioning to Full Mobility
Once crutches are discontinued, the focus shifts to formal physical therapy aimed at restoring the knee’s full range of motion and functional strength. Therapy often begins seven to ten days after the procedure, once initial surgical swelling is managed. Early goals include achieving complete knee extension (straightening) and at least 90 to 120 degrees of knee flexion (bending).
The rehabilitation program progresses from basic strengthening exercises, such as straight leg raises, to more functional closed-chain activities like mini-squats and leg presses. Strengthening the surrounding muscles, particularly the quadriceps and hamstrings, protects the joint and prevents symptom recurrence. This phase emphasizes movement quality to ensure proper joint mechanics are re-established.
Patients can return to sedentary work within a few days of surgery. However, the timeline for resuming activities like driving is longer, often a week or more, especially if the right leg was operated on. Full return to pre-injury activity, including jogging or sports, is a gradual process spanning six to twelve weeks, guided by the physical therapist based on demonstrated strength, endurance, and absence of pain or swelling.