About Plica-Syndrome

The plica is a fold of joint lining (synovial tissue) that is a remnant of tissue from embryologic development. During embryologic development, bands of tissue divide the limbs into joints. These bands may persist into adulthood in up to 60% of people, although it infrequently causes symptoms. Several different band types may exist. These bands may become thickened and inflamed, causing varying symptoms and when this condition exists it is often labeled as plica-syndrome.

Common Signs and Symptoms

• Pain in the front of the knee, often toward the inside of the knee, especially with kneeling, squatting, sitting for long periods, arising from a sitting position, or walking or running up or down stairs or hills

• Catching, locking, and clicking of the knee

• Pain and tenderness under the kneecap (patella)

Causes of Plica-Syndrome:

• Trauma to the knee, either direct or with repetitive knee bending and straightening activity, causes thickening of the plica, and it loses its elasticity (becomes less stretchy). As a result, the plica pinches on the inner knee joint (medial femoral condyle) and inner patella. The pain is felt to be due to pinching or pulling of the plica band, which has many nerve endings.

Risk Increases With:

• Sports that require repeated, forceful straightening or bending of the knee (such as kicking and jumping)

• Repeated injuries to the knee

• Sports in which the knee may receive direct injury (volleyball, soccer, football) or that require prolonged kneeling

Preventive Measures:

• Proper padding can reduce direct injury to the fat pad.

• Allow complete recovery before returning to sports.

Expected Outcome:

Usually there is complete recovery with proper treatment.

Possible Complications:

• Frequent recurrence of symptoms, resulting in chronically inflamed tissue and eventually a chronic problem

• Disability severe enough to diminish an athlete’s competitive ability

• Delayed healing or resolution of symptoms, particularly if activity is resumed too soon

• Risks of surgery, including infection, bleeding, injury to nerves (numbness, weakness, paralysis), continued pain and pinching of the fat pad, and rupture of the patellar tendon


General Treatment Considerations with Plica-Syndrome

Initial treatment consists of medications and ice to relieve pain and reduce inflammation, stretching and strengthening exercises (of the hamstrings and quadriceps), and modification of the activity that produces the symptoms. These may be carried out at home, although occasionally referral to a physical therapist or athletic trainer may be indicated.

Occasionally your physician may recommend an injection of cortisone to reduce the inflammation of the plica. Arch supports may also be recommended. Surgery is not usually necessary; it is usually reserved for cases in which symptoms persist despite conservative treatment. Surgery to remove the plica is usually performed arthroscopically on an outpatient basis (you go home the same day).

Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetamino-phen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Topical ointments may be of benefit.

• Stronger pain relievers may be prescribed as necessary by your physician, usually only after surgery. Use only as directed and only as much as you need.

• Injections of corticosteroids may be given to reduce inflammation, although not usually for acute injuries

Heat and Cold

Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.


Contact My Physical Therapy Coach or your own PT if:



• Symptoms get worse or do not improve in 2 weeks despite treatment

• Any of the following occur after you have surgery:

o You experience pain, numbness, or coldness in the foot and ankle

o Blue, gray, or dusky color appears in the toenails

o You develop increased pain, swelling, redness, drainage, or bleeding in the surgical area

o Signs of infection occur (headache, muscle aches, dizziness, or a general ill feeling with fever)

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)

EXERCISES for Plica-Syndrome


Contact my-physical-therapy-coach to receive detailed exercise instructions for Plica-Syndrome

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