Plica Syndrome - Part 2 - Surgery + Post-Surgery

Just got home from my knee arthoscopy surgery for my plica syndrome!

I decided to journal my experience so others can have a point of reference.

To read more about my exact condition, you can check out part 1 here.

After a long time of ruminating and consideration, I decided to go for a knee arthroscopy surgery. According to my doctor Lim Mui Hong, it’s a fairly minor surgery with low risk. He seemed quite confident so that was reassuring.

My surgery was scheduled at 9.30AM, which meant I was asked to check in to Mount Alvernia Hospital at 7.30AM. I had to fast for >8h before the surgery, which meant I skipped breakfast and didn’t drink anything in the morning (I read that you can actually drink, just not eat. All the Nurses who asked me a gazillion times also only asked ‘when was your last meal’ and didn’t ask when did I last drink water so.... maybe you can drink? Check with your doctor)

Checking in was pretty fast, and I was changed into my operating gown by 8+ and chilling in my ward. As it was my first surgery, I was pretty nervous and didn’t know what to expect. Thankfully the Wife was with me!

Just before 9, someone came to wheel me up to the operation theater. It is time!!

It was a surreal feeling being wheeled in the bed/gurney... slightly disconcerting.

When I reached upstairs, I had to wait again as it wasn’t time yet. It was an uncomfortable (and cold!) 20+ mins as I heard patients being wheeled around me and heart rate monitors beeping out of rhythm. Can be quite unnerving! Not sure why the air con was so cold too, won’t the surgeon shiver or something.

Luckily the surgery was very punctual - at 9.25 my anaestheologist came to me and briefly explained what was going to happen. ‘You will go to sleep, and it will be done!’ He said cheerfully.

THEN he wheeled me into the operating theatre and suddenly like ten different things were happening at once. Someone was preparing the operating table for me, another put a heart rate monitor on my chest, another took my pulse, the anaestheologist was inserting the tube into my hand which my GA would be fed in, and my surgeon was jokingly asking me ‘so which knee ah?’ It was very confusing, but impressively efficient too as each staff worked like cogs of a wheel and had me all hooked up and ready to go within a minute.

I wasn’t asked to count down from a 100, unlike all those stories you hear. I don’t really remember what the last thing said to me was, probably ‘is that bozo still awake?’., I don’t remember dozing off. Next thing I knew I woke up in my ward, about 1.5h later, and my whole body felt like it was still asleep due to the GA still in my system.. I groggily said some stuff to my wife to tell her I’m awake then went back to sleep as the drugs slowly wore off.

I was kept in bed for another few hours (including a lunch break of porridge) and my surgeon came by at 3+ to check on me. Everything went smoothly, and he told me to do some quad squeezing and leg extension/flexion, with the goal of regaining full range of motion.

Currently my knee feels very tight, and I can’t bend it nor extend it fully yet, especially with the thick bandages still wrapped around it. Quite hard to move around without crutches too since the joint is quite weak and stiff.

Hope it gets better quick! Will be going back to see him for a follow up in 4 days time, and also see the physio for some PT.

My Plica Syndrome - Part 1 - Pre-surgery

It was a seemingly harmless niggling feeling in my knee after running.

I decided nothing too bad, and went for another run the next day. And then walked a whole bunch in Korea the following week.

What followed was a 9 month long knee pain/discomfort that I couldn't really explain for the first 6 months until MRI results showed a medial plica in my left knee that was possibly causing my problems.

red area is where the pain/discomfort is. Blue areas are where i experience tightness for unknown reasons.

My exact symptoms evolved and varied with time, but some of them:
- Tightness in both quads, at the blue spots marked above
- Tightness in hamstrings
- Abovementioned tightness would happen mostly with prolonged standing, and very oddly, when any fabric rested on my knees.
- Rubbing sensation on the inside of left knee (plica)
- Knee would feel warm at the red region after certain exercises (e.g. deadlift)
- Weakness/tight feeling in left knee.
- Tightness can evolve to pain if I keep applying pressure on left knee.

I did everything - see multiple doctors and specialists, physios, even TCM. But nothing helped. I stretched diligently every day, foam rolled. But nothing helped.

So after a long and fruitless battle... I gave in and decided to try for the last resort, surgery. It would be a simple procedure - a knee arthroscopy, where the doctor makes 2 small incisions on each side of the knee, and goes in to shave away the plica.

The thing is, there is no guarantee that this will take away my problems. It is the best hypothesis as to what was causing it, as doctors had ruled out ligament / meniscus damage. I'm quite apprehensive of this surgery, as I've never gone for surgery (or been under GA) before.

My surgery will be in 2 week's time... I'm hoping it will go smoothly, and recovery will be quick and easy. I'll update again then.

A new bulk and cut cycle

I started taking my diet seriously in August 2017, and I saw the most pronounced changes in my body composition that I've ever seen in my life (and I've been training on / off for about 5 years).

In mid-Aug 2017, I started a bulk that ended about Nov 2017. In that period, I went from around 66-67 kg to 73.3kg, the heaviest I had weighed in my life.
Nov 2017 - Feb 2018: Started cutting, went down to 67kg
Feb 2018 - Apr 2018: Started bulking, went from 67kg to 71kg
Apr 2018 - Jun 2018 : Started cutting, went down to 65kg (current).

I'm at the tail end of this cut, and aiming to end at about 64kg so that I will be really lean, and plan to start on a much slower bulk.

From the previous experiences in bulking (especially the first bulk cycle in Aug-Nov 2017), going up too quickly (0.5kg seemed a bit too fast) just made me look fat at the end of my bulk. My previous cut to 67kg I didn't really see leanness/abs that I liked, hence I pushed lower this time with the goal of 64kg. Realistically, I think I'll need to hit 62kg to really get the 'shredded' look, but I don't think I can bring myself to do that.

First, some progress pics:

Even though I lost 8(!) kg, my muscles actually look more defined. It's clearer in the next picture. 

Gosh, I look overweight in the 1st pic. 

For this upcoming bulk, I'm planning to REALLY take it slow, aiming for just about 0.5-0.6kg gain in two weeks. I'm hoping that this slow bulk will mean I retain my leanness as I put on mass. The target is to hit about 69-70kg in 16 weeks, eat at maintenance for 2 weeks (apparently helps to reset hypertrophy pathways), then cut back down to 65 in 8 weeks (i.e. half a year; 26 weeks cycle). The general goal is to push up my 'bottom weight' by 1kg each cycle.

I'm not sure how easy it will be to maintain a constant rate of weight gain/loss, and I'm expecting to hit some unexpected plateaus or spikes that will necessitate some modifications to the plan, but I plan to bump up my calories by 200 initially (assume that's about maintenance for me) for a week. If no weight change, I will bump it up by another 100. If there's weight change, I will maintain that calorie intake until weight gain slows to less than 0.15 a week. For bulk phase, I will not be rushing, so I foresee I may actually end up under 70kg at the end of 16 weeks. For the cut phase, I will be more aggressive in my reduction of calories if my weight doesn't move week-on-week.

The eventual goal is to walk around at 70kg, lean, and maintain that. To achieve that, it seems like it will take 3 years, assuming a 6 month bulk/cut cycle. So will I have a lean, mean physique in 2021? I certainly hope so!

Some of the changes that I will be adapting for this bulk cycle is also to try to maintain a 50:50 eat clean ratio. Previously, I was more or less going IIFYM style, eating whatever just to hit my calorie target. I will be more deliberate this time, and hopefully it will help maintain leanness.

Training-wise, I will stick to N-suns for a while, and hope that I can break 100kg on Bench Press once I start eating more (I was at 97.5kg for 3 reps at one point). I have little doubt this programming will help me bring my Deadlift (once I can start doing it) up to 100kg (and beyond) too, so I'm looking forward to that. Hope my knee gets fixed soon.