Updated: 5/31/2021

Plicae

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  • 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

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