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Plica Syndrome M67.50 727.83

 medial patellar plica

synonyms:plica syndrome, plica synovialis, medial patellar plica

Plica Syndrome ICD-10

Plica Syndrome ICD-9

  • 727.83 (Plica knee)

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


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