Medial Plica Syndrome

Fig. 112 Excision of the plica (seen by arthroscopy) usually relieves symptoms

SYMPTOMS There is gradual onset of diffuse or localised exercise-induced pain around the anterior part of the knee. Prolonged sitting and squatting often trigger the symptoms (positive movie sign). Walking down stairs is worse than up. Clicking or pseudo-locking during deep squats are common.

AETIOLOGY The medial plica is a vestigial tissue that many people have but with no symptoms. It connects the anterior fat pad with the medial knee joint capsule. Pain from an inflamed or fibrotic plica may either occur from direct contusions or sometimes as a result of sudden changes in training habits, such as an increase in intensity or amount of impact.

CLINICAL FINDINGS There is effusion and tenderness on palpation in the medial anterior joint line. The plica test is often positive. INVESTIGATIONS X-ray can exclude fractures, OCD, osteochondral injuries and bone tumours. MRI can exclude soft tissue tumours and other

Fig. 113 Plica test is usually positive but not specific to this condition localised soft tissue lesions but often miss the plica since it is commonly seen in unsymptomatic knees. MRI thus often underestimates chondromalacia and other superficial chondral injuries as well as many meniscal tears and medial plica syndrome. Ultrasound can be useful for differentiating functional tendon and ligament disorders such as jumper's knee or tendinosis around the knee. This condition is usually diagnosed and treated by arthroscopy.

TREATMENT Arthroscopic excision of the painful plica shows excellent outcomes. REFERRALS These patients are very much helped by being evaluated clinically by their physician, surgeon and physiotherapist in close collaboration since there are many differential diagnoses (see anterior knee pain).

EXERCISE PRESCRIPTION Cycling and swimming are good alternatives to keep up general fitness. Running and jumping is usually allowed within a few weeks of surgery.

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