synonyms:plica syndrome, plica synovialis, medial patellar plica
Plica Syndrome ICD-10
Plica Syndrome ICD-9
Plica Syndrome Etiology / Epidemiology / Natural History
- Plica Sydrome = painful impairment of knee function were the only finding to explain the symptoms is the presence of a thickened, hypertrophic plica. (Ewing JW, JAAOS 1993;1:117)
- Plica Synovialis = a membranous fold or ridge found in the synovial lining of a joint. (Ewing JW, JAAOS 1993;1:117)
Plica Syndrome Anatomy
- Plica Synovialis Patellaris = ligamentum mucosum: found in the intercondylar notch,
extends from the femur to the tibial plateau covering the anterior cruciate ligament.
- Plica synovialis suprapatellaris = suprapatellar plica: found in the suprapatellar space, extending from the medial capsule of the knee toward the lateral capsule with various patterns.
- Plica synovialis mediopatellaris = medial plica: extends from the infrapatellar fat pad to the medial capsule of the knee, in the coronal plane.
- Plica synovialis lateropatellaris = lateral plica: rarely seen, extends from the infrapatellar fat pad to the lateral capsule of the knee, in the coronal plane.
Plica Syndrome Clinical Evaluation
- Chronic anteromedial knee pain and tightness in the subpatellar region on squatting
- 50% have history of blunt trauma to the anterior knee. Often with a latent period symptom free period after the initial injury with delayed onset of anterior knee pain weeks or months later.
- May have anterior knee pain after prolonged strenuous physical activity; running, weight lifting, step aerobics.
- Tenderness in the medial parapatellar region.
- Holding test: The patient holds resistance as the knee is flexed from full extension to full flexion with a medial directed force on the patella. Pain produced with or without a click indicates plica syndrome.
- (Irha E, JPO 2003;12B:44)
Plica Syndrome Xray / Diagnositc Tests
- A/P, lateral views of the knee indicated. Usually normal.
- MRI generally indicated to rule out other causes of knee pain such as meniscal tear. A plica noted on MRI is not diagnositic of plica syndrome as most plica's are asymptomatic.
Plica Syndrome Classification / Treatment
- Nonsurgical: activity modifications, NSAIDs, moist heat, hamstring stretching.
- Surgical: pathologic medial plica has the feel of a taut bowstring and appears as a thickened, avascular, wide (greater than 12mm), membranous band. Treatment is Arthroscopic Plica Excision (29875).
Plica Syndrome Associated Injuries / Differential Diagnosis
Plica Syndrome Complications
Plica Syndrome Follow-up Care
Plica Syndrome Review References