Plica Syndrome

Aka: Plica Syndrome, Synovial Plicae of the Knee

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II. Definitions (based on arthroscopy)

  1. Pleats of synovial lining of the knee
  2. Four Plicae
    1. Inferior plica (ligamentum mucosum)
      1. Intercondylar
      2. Anterior to anterior cruciate ligament
    2. Superior plica (plica synovialis suprapatellaris)
      1. Suprapatellar region (2 cm above Patella)
    3. Medial plica (plica synovialis Patellaris)
      1. Five anatomic subsets of the plica
      2. One finger breadth lateral to medial Patella
    4. Lateral plica (rarely injured)
      1. Five anatomic subsets

III. Mechanism of Injury

  1. More common in teenage athletes
  2. Onset often after blunt or twisting Knee Injury
  3. Repetitive knee flexion-extension
    1. Rowing
    2. Swimming
    3. Cycling

IV. Symptoms

  1. Medial Patella pain
  2. Snapping Sensation with knee flexion
  3. Provocative: Repeated flexion and extension motion
    1. Walking up and down stairs
    2. Squatting

V. Signs

  1. Painful arc at 30 to 60 degrees
  2. Medial to Patella above joint line
  3. Painful cord palpable alongside medial edge of Patella
  4. Palpation reproduces symptoms

VI. Management

  1. Eliminate or reduce provocative activities
    1. Cycling
    2. Stair-step machine
  2. Local Cold Therapy
  3. Consider local Corticosteroid Injection
  4. Consider arthroscopic repair

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