Plica syndrome is usually a group of condition associated primarily with irritation, inflammation and enlargement of plica (an extension of the synovial capsule of the knee).
Plica is thought to be the remnants of embryonic connective tissue that failed to fully resorb during your foetal development, present in 45-50% of the population.
Knee potentially has four plica, while the medial plica is most likely to be symptomatic. It runs parallel to medial patella just below the medial retinaculum and inserts into the fat pad.
Things that can lead to plica syndrome are –
- repetitive knee straightening and bending,
- blunt trauma or knee twisting,
- fat pad irritation,
- altered knee motion,
- Internal knee derangements e.g. Meniscal tears.
Plica syndrome usually doesn’t occur in isolation, but associated with other knee conditions such as meniscal injuries, patellar tendonitis and Osgood-Schlatter’s Disease.
PATIENTS USUALLY COMPLAINS OF–
- Anteromedial knee pain – especially medial femoral condyle.
- Visible and palpably tender plica.
- Audible clicking or snap during knee motion – painful arc 30 to 60 degrees.
- Positive Duvet test: pain eased by using a duvet between your knees to ease pain in bed.
- Pain with activities: ascending and descending stairs, squatting, rising from a chair and/or sitting for extended periods.
- Quadriceps atrophy is common in chronic cases.
A thorough examination can clinically diagnose the condition. Plica syndrome is usually associated with other condition which also needs to be ruled out.
X-ray may be useful to rule out other associated pathologies. MRIs can identify plica inflammation. However, MRI is more useful for diagnosing other pathologies that may be related to the plica irritation.
More than 3/4th of the patients with plica syndrome recover successfully with conservative physiotherapy treatment within 6 to 8 weeks.
Physiotherapy treatment aims:
- Control pain and inflammation
- Improve patellofemoral (knee cap) alignment via taping, bracing and exercises.
- Adequate length of musculature around the joint especially the TFL and IT band.
- Strengthen your knee: especially VMO part of quadriceps.
- Strengthening hip and lower limb muscles.
- Foot biomechanics correction.
- Proprioception, agility and balance training.
- Improving lower limb function and movement e.g. walking, running, squatting, hopping and landing.
- Minimizing the chances of re-aggravating the syndrome (precautions)
If the symptoms persist beyond 3 to 6 months, arthroscopic knee surgery for a plica syndrome may be considered. The surgeon releases the lateral retinacular to allow the patella to track more medially and thereby minimizing plica irritation as it rolls over the medial femoral condyle.
Since plica syndrome usually occurs with other knee conditions, it is important to be proactive in managing other knee injuries. This involves maintaining normal knee joint alignment, adequate strength and flexibility in the muscles around the knee joint and the other muscles of the lower limb.
Proper supportive footwear that maintains the arches so that biomechanical faults doesn’t occur. Also, weight-management can play an important role as it exerts pressure on lower limb joints, and thus should be considered as a long-term preventative measure.
Braces for Plica Irritation
Many patients can try a knee brace. Brace that improve patellofemoral joint alignment seem to be the most effective to ease plica-related pain.