Plica syndrome

Question 1

How does the Plica Syndrome form?

Answer 1

When the 3 synovial chambers in the knee do not resorb into one by the 3rd or 4th month of a fetal life causing separation to persist in the knee. These embryonic remnants are known as synovial plicae.

Question 2

What does plicae mean in Latin?

Answer 2

Fold

Question 3

What are the 3 common plicae and their locations?

Answer 3

Suprapatellar: extends from the under surface of the quadriceps tendon to the medial or lateral capsule of the knee.

Medial: extends from the medial joint capsule to the
medial anterior fat pad.

Infrapatellar: extends anterior to and sometimes over the
ACL.

Question 4

What causes this injury?

Answer 4

Inflammation from trauma and overuse

Muscular imbalances in the quadriceps, hamstrings, or hip musculature

Question 5

Describe clinical presentations of PS

Answer 5

Insidious pain usually in the inferomedial quadrant of the knee

• Painful ‘popping’ or ‘snapping’
• Buckling of the knee or sense of instability

Question 6

What type of imaging will be most useful?

Answer 6

An MRI to see the state of the plical tissue.

Question 7

What would we expect to feel during palpation of the syndrome?

Answer 7

A thickened band

Question 8

What could be some adverse outcomes of this syndrome?

Answer 8

Erosive changes of the femoral condyle cartilage due to the thickened pliace ‘snapping’ over the condyle with continued exercise (running).

Question 9

What is the primary goal in treating plica syndrome

Answer 9

Reduce the inflammation. Using NSAID’s (ibuprofen/aspirin) and limiting activities like running, biking, or using a stair-climbing machine.
Encourage movement to move fluid in the area
Decrease tension in muscles surrounding the joint