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Plicae

Topic updated on 06/30/14 3:35pm
Introduction
  •  Plica syndrome
    • defined as a painful impairment of knee function resulting from the thickened and inflamed synovial folds
      • usually only medial plica
    • 50% present with history of blunt trauma to the anterior knee
  • Plica 
    • are embryologic remnant synovial folds. Most common plicae are  
      • ligamentum mucosum
        • most common plica
        • located in the intercondylar notch
      • suprapatellar plica
        • located in the suprapatellar space, extending from the medial wall of the knee toward the lateral wall
      • medial plica
        • extends from the infrapatellar fat pad to the medial wall of the knee
        • most commonly irritated from the abrading the medial femoral condyle
Presentation
  • Symptoms
    • snapping sensations
    • buckling
    • knee pain on sitting
    • pain with repetitive activity
  • Physical exam
    • tenderness in the medial parapatellar region
    • painful, palpable medial parapatellar cord
      • can be rolled and popped beneath the examiners finger
    • provacative test 
      • hold the knee in full extension while examiner tries to flex against the patient’s resistance.
      • the examiner again pushes the patella medially while palpating its medial border.
      • pain produced with or without a click is considered a positive test.
Imaging
  • MRI
    • can detect plica but has low sensitivity
Treatment
  • Nonoperative
    • activity restriction, NSAIDS, and physical therapy
      • indications
        • most cases can be treated nonoperatively
      • physical therapy
        • moist heat applications
        • hamstring stretching
        • resistive strengthening exercises are avoided in early rehabilitation phases
  • Operative
    • arthroscopic resection of lesion 
      • indications
        • only utilized in rare cases of plica band syndrome not responding to nonoperative treatment

 

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Arthroscopic treatment of pelicans syndrome of the knee.
4/21/2013
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