- 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 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
Results of resection of medial patellar plica through a supero-lateral portal as a main arthroscopic procedure.
Symptomatic Synovial Plicae of the Knee.
The pathological medial plica: criteria for diagnosis and prognosis.
Diagnosis and treatment of the plica syndrome of the knee.
The plica syndrome: a new perspective.
Symptomatic synovial plicae of the knee.
The pathological plica in the knee. Results after arthroscopic resection.