

KNEE SURGERY

	KNEE REPLACEMENT ARTHROSCOPIC PROCEDURES KNEE ANATOMY AND FUNCTION
KNEE CONDITIONS

	PATELLAR TENDONITIS CHONDROMALACIA PATELLA RUNNERS KNEE BAKER'S CYST BURSITIS ARTHRITIS OSTEOARTHRITIS PLICA SYNDROME OSGOOD-SCHLATTER DISEASE OSTEOCHONDRITIS (OCD) PATELLOFEMORAL DISORDERS
KNEE INJURIES

	ANTERIOR CRUCIATE LIGAMENT INJURY (ACL) ARTICULAR CARTILAGE LESIONS LATERAL COLLATERAL LIGAMENT INJURY (LCL) MEDIAL COLLATERAL LIGAMENT INJURY (MCL) PATELLAR TENDON RUPTURE POSTERIOR CRUCIATE LIGAMENT INJURY (PCL) TORN MENISCUS (Cartilage) FRACTURES & DISLOCATIONS
PATIENT RESOURCES

	SPORTS RELATED KNEE INJURIES BEFORE KNEE SURGERY KNEE SURGERY RECOVERY Insurance Carriers

Plica Syndrome

A plica is a thin wall of fibrous tissue that are extensions of the synovial capsule of the knee. During fetal development, the knee is divided into three (3) separate compartments. As the fetus develops these compartments develop into one large protective cavity (synovial membrane). The majority of people have remnants of these three cavities referred to as a plica. Most often the plica is on the medial (inside) of the knee at the level of the medial femoral condyle. Most individuals are not adversely affected by the presence of plicas.

The plica only becomes a problem when the knee is irritated, causing an inflammation in the synovial sack. When the synovium is inflamed, the area of the plica becomes thicker. This thickened area then begins to catch on the femur as the knee moves. This in turn keeps the plica inflamed resulting in a viscous cycle.

The plica can be located anywhere in the knee. The exact symptoms will be determined by the plica’s location. The most common location is along the medial (inside) side of the knee. The plica can tether the patella to the femur, be located between the femur and patella, or located along the femoral condyle. Regardless of location the pain is due to the plica catching or being pinched between the patella and femur. If the plica connects the patella to the femoral condyle, symptoms will mimic patello-femoral syndrome.

Usually plica syndrome is characterized by pain near the anteromedial (in front and toward the midline) side of patella (kneecap). Usually the pain is associated with bending of the knee and is irritated after and during exercise. You may also feel a snapping or popping sensation when you bend your knee, or suffer tenderness on the inner side of your knee. Your knee may be unstable at times. If irritation is widespread, your whole knee may become swollen. If you're particularly thin, you may actually be able to feel a tender band of plica tissue under your skin.

Plica syndrome is caused by chronic inflammation from trauma to the knee or other pathological knee conditions. Normally the plica synovial membranes are thin and elastic. When these membranes become inflamed over time they can lose their elasticity and become thickened and fibrotic. This causes the plica to interfere with the normal dynamic function of the knee, manifesting in symptoms that are similar to many other knee problems. Symptomatic plica, are, as stated, rare. The medial (mediopatellar) plica is the most widely reported to be symptomatic. Symptomatic suprapatella and lateral plicae have also been reported, but much more rarely

Diagnosis begins with a history and physical. The examination will try to determine where the pain is located and whether or not the band of tissue can be felt. X-rays will not show a plica. X-rays are mainly useful to determine if other conditions are present if there is not a clear cut diagnosis. If there is a uncertainty in the diagnosis following the history and physical examination, or if other injuries in addition to the plica syndrome are suspected, a MRI scan may be suggested. The MRI (Magnetic Resonance Imaging) machine uses magnetic waves rather than x-rays, to show the soft tissues of the body. With this machine, we are able to “slice” through the area we are interested in very clearly. Usually, this test is done to look for injuries, such as tears in the menisci or ligaments of the knee. This test does not require any needles or special dye, and is painless. Most cases of plica syndrome will not require special tests such as the MRI scan.

If the history and physical examination strongly suggest that a plica syndrome is present, then arthroscopy may be suggested to confirm the diagnosis and treat the problem at the same time. Arthroscopy is a type of an operation where a small fiberoptic TV camera is placed into the knee joint, allowing the orthopedic surgeon to look at the structures inside the knee joint directly. The arthroscope allows your doctor to actually look into the knee joint and see the condition of the whole knee and see if an inflamed plica exists.

Usually, the arthroscope is used to remove a plica. Arthroscopy is a surgical procedure that is done as an outpatient procedure. A small TV camera is inserted into the knee joint through small 1/4 inch incisions. Once the plica is located with the arthroscope, small instruments can be inserted through another 1/4 inch incision to cut away the plica tissue and remove the structure. The area where the plica is removed heals back with scar tissue. There are no known problems associated with not having a plica, so you won’t miss the structure. Usually, there is very little rehabilitation after surgery to remove a plica and you will probably be on your feet immediately after surgery.