> Plica Syndrome
What are Plicae?
Plicae are thin walls of fibrous
tissue, which are thickenings of the lining of the knee
joint, or synovium. In a developing fetus, the plicae
separate the three compartments of the knee. In about
one-third of the population, by the fourth month of
fetal development the plicae combine to form one large
protective cavity for the knee. For the majority of
people, however, some or all of the plicae remain in
the knee joint.
Plica syndrome is an irritation of the plicae that occurs
over time due to repetitive motion, or an acute injury,
which can cause the plicae to swell, thicken, and ultimately
cause pain. In some cases, plicae can become caught
between the kneecap and thighbone (femur), causing pain
and discomfort. Or, they can scrape the surface of the
articular cartilage that cushions the ends of the shinbone
and thighbone, which can lead to arthritis.
Repeated bending and straightening
of the knee, such as the motions used in cycling or
using a stair-climbing machine, can contribute to plica
syndrome. So can a blow to the inside (big-toe side)
of the knee, where the medial plica is located.
It is often difficult to determine
whether removing the plicae surgically makes a significant
difference in knee function. The proof may not come
until several months later. However, surgical removal
of plicae has not been shown to adversely affect knee
strength and stability. In some instances, if you are
experiencing knee pain for no apparent reason, a misaligned
kneecap may be the cause of your symptoms. If you are
going to receive a cortisone treatment for plica syndrome,
remember that there is a risk of infection any time
an injection is made into a joint. Standard sterile
technique is used whenever an injection is given. This
involves cleansing the skin with an antiseptic such
as betadine prior to inserting the needle.
| Orthopedic Evaluation
are usually three parts of an orthopedic evaluation:
medical history, physical examination, and tests your
physician may order.
Since plica syndrome shares many symptoms with other knee
ailments, it is important to be as accurate as possible
in describing your symptoms to your doctor. Even then,
other possibilities will have to be ruled out before a
diagnosis of plica syndrome is made. Your physician also
typically will ask about other conditions, such as diabetes
and allergies, and medications currently being taken.
Your physician will check for swelling and for the location
of pain, and to see if he can feel the plica band. He
may ask you to flex and extend your knee while he is
performing these tests.
Plicae can only be seen through an arthroscope,
which will reveal any inflammation that may exist. MRI
(magnetic resonance imaging) can detect ligament or
cartilage damage, and therefore can rule out those injuries.
X-rays can determine other conditions, such as bone
injuries. Before arthroscopy is requested, all other
possibilities should be considered first.