Summary Plica syndrome is defined as a painful impairment of knee function resulting from the thickened and inflamed synovial folds (usually medial). Diagnosis is made clinically with pain over the medial parapatellar region with possible palpation of a thickened cord. Treatment is mainly nonoperative with NSAIDs and physical therapy to focus on hamstring strengthening. Arthroscopic plica excision is indicated in refractory cases that fail nonoperative treatment. Etiology Pathophysiology 50% present with history of blunt trauma to the anterior knee Plica are embryologic remnant synovial folds. Most common plicae are ligamentum mucosum most common plica located in the intercondylar notch suprapatellar plica located in the suprapatellar space, extending from the medial wall of the knee toward the lateral wall medial plica extends from the infrapatellar fat pad to the medial wall of the knee most commonly irritated from the abrading the medial femoral condyle Presentation Symptoms snapping sensations buckling knee pain on sitting pain with repetitive activity Physical exam tenderness in the medial parapatellar region painful, palpable medial parapatellar cord can be rolled and popped beneath the examiners finger provacative test hold the knee in full extension while examiner tries to flex against the patient’s resistance. the examiner again pushes the patella medially while palpating its medial border. pain produced with or without a click is considered a positive test. Imaging MRI can detect plica but has low sensitivity Treatment Nonoperative activity restriction, NSAIDS, and physical therapy indications most cases can be treated nonoperatively physical therapy moist heat applications hamstring stretching resistive strengthening exercises are avoided in early rehabilitation phases Operative arthroscopic resection of lesion indications only utilized in rare cases of plica band syndrome not responding to nonoperative treatment