- Discussion:
- most common form of plica;
- located over the medial femoral condyle;
- vulnerable to direct trauma when the knee is flexed;
- repeated trauma or irritation may lead to inflammation and fibrosis of the plica;
- fibrotic plica has decreased elasticity which causes it to impinge on
either the patella or the femoral condyle;
- Clinical Manifestations: (Medial Plica)
- diagnosis of symptomatic plica is made by exclusion; and presence of a plica
by itself, does not connote pathology;
- symptoms may mimic those of a torn meniscus (eg. snapping, clicking, &
medial joint line tenderness;
- anterior knee tenderness may be attributed to the anteiror extension of the plica
to the fat pad;
- when thickened, the medial plicae may be palpated just above the joint line;
- palpation of the plica may be facilitated by having the patient flex & extend
knee while the surgeon palpates the medial condyle next to patella;
- Treatment:
- symptomatic plicae are managed with rest &
NSAIDS;
- excision, while rarely indicated, is very effective when necessary;
- Arthroscopic Treatment: (
knee arthroscopy);
- position for arthroscopic visualization:
- knee is extended;
- joint is repeatedly flexed to check for impingement of medio-patellar plica
on the medial femoral condyle or patella;
- normal findings:
- it runs along medial capsular wall between infrapatellar fat pad and the
medial capsule, hence dividing wall into a superior and inferior portion;
- pathologic plica:
- look for thickened shelf that impinges on medial femoral condyle or patella during flexion;
- also look for evidence of femoral condylar cartilage damage from the plica;
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RMP Sherman and RW Jackson. JBJS 71-B. p 351. 1989.
Diagnosis and treatment of the plicae syndrome of the knee.
Hardaker WT et al. JBJS. 62-A. p 221-225. 1980.
The plica syndrome: a new perspective.
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Symptomatic synovial plicae of the knee.
DP Johnson et al. JBJS 75-A. p 1485-1496. 1993.
The pathological plica in the knee: results after arthroscopic resection.
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