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Introduction

Knee Pain

Plica Syndrome

A plica or synovial plica is a band of synovial tissue found in the knee joint. Plica syndrome, also known as medial plica syndrome, usually affects the medial plica (on the inner side of the knee). There are also other plicae at the knee such as lateral plica, medial suprapatellar plica, lateral suprapatellar plica, suprapatellar septum, and ligamentum mucosum. Plica syndrome occurs when the plica becomes irritated and inflamed from repetitive friction.

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Causes

Some potential causes of plica syndrome include:

  • Overuse: repetitive movements such as bending and extending the knee joint.

  • Injury: high-impact trauma such as a car accident or a blow to the knee. 

  • Health conditions: underlying health conditions such as hemarthrosis secondary to haemophilia, intra-articular lesions, loose foreign bodies, and rheumatoid arthritis can lead to plica syndrome. 

Symptoms

Symptoms of plica syndrome include:

  • A “pop” or “snap” sensation in the knee during certain movements

  • Pain and discomfort in front of the knee

  • Swelling and stiffness in the affected knee joint

  • Impaired range of motion

  • Tenderness and sensitivity in the affected area

  • Instability and weakness in the affected knee

Diagnosis

Plica syndrome is one of the trickier knee injuries to diagnose as it tends to show similar symptoms to other knee conditions, hence proper diagnosis with an orthopaedist is necessary.

Diagnosis of plica syndrome occurs in the following ways:

  • Physical examination and medical history: inform your orthopaedist of the potential activities that may have led to an injury such as trauma, exercise, or sports and underlying health conditions that are plausible causes of plica syndrome. The knee will be particularly investigated for a palpable taut band in the middle of the knee. Physical tests such as the Stutter test and the Hughston test would be administered to confirm the diagnosis. 

  • Imaging tests: magnetic resonance imaging (MRI) or dynamic ultrasonography will provide clarity if medial plica is present. These imaging tests also work to rule out other knee problems.

Non-surgical treatments
  • Rest: you would be advised to observe complete rest to relieve pain and reduce inflammation of the plica.

  • Medications: non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers are commonly prescribed as the first course of treatment to reduce inflammation and manage pain.

  • Injections: corticosteroid injections may be administered to reduce inflammation and provide immediate relief. 

  • Brace: to reduce movement of the knee and manage inflammation and pain. 

  • Crutches: to limit placing weight on the affected knee.

Surgery