eMedicine Specialties > Sports Medicine > Knee

Medial Synovial Plica Irritation: Differential Diagnoses & Workup

Author: Robert F LaPrade, MD, PhD, Professor, Department of Orthopaedic Surgery, Divisions of Sports Medicine and Shoulder Services, University of Minnesota
Contributor Information and Disclosures

Updated: Oct 15, 2007

Differential Diagnoses

Meniscus Injuries
Patellar Injury and Dislocation
Patellofemoral Joint Syndromes
Pes Anserine Bursitis

Other Problems to Be Considered

Knee Osteochondritis Dissecans
Medial meniscus tear

Workup

Imaging Studies

  • Plain radiographs should be ordered in most patients to rule out the differential diagnosis or concurrent possible pathology of a medial synovial plica. Routine radiographs should include a standing anteroposterior (AP), lateral view, and a 45° patellofemoral view. These radiographs help to demonstrate any evidence of medial compartment arthritis, osteochondritis dissecans, or patellofemoral joint pathology.(See also the eMedicine articles Knee Osteochondritis Dissecans, as well as Medial Compartment Arthritis and Osteochondritis Dissecans [in the Orthopedic Surgery section].)
  • Magnetic resonance imaging (MRI) may also be useful to confirm the presence of a thickened plica (axial view) and to rule out other causes of medial-sided knee pain (eg, medial meniscus tear, bone bruise, osteochondritis dissecans).

Procedures

  • Diagnostic intra-articular lidocaine injections can be useful in some patients in whom it is difficult to determine if the pathology is intra-articular or extra-articular. Continued pain after an intra-articular lidocaine injection would point to an extra-articular cause of a patient's pain.

More on Medial Synovial Plica Irritation

Overview: Medial Synovial Plica Irritation
Differential Diagnoses & Workup: Medial Synovial Plica Irritation
Treatment & Medication: Medial Synovial Plica Irritation
Follow-up: Medial Synovial Plica Irritation
Multimedia: Medial Synovial Plica Irritation
References
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References

  1. Amatuzzi MM, Fazzi A, Varella MH. Pathologic synovial plica of the knee. Results of conservative treatment. Am J Sports Med. Sep-Oct 1990;18(5):466-9. [Medline].

  2. Broom MJ, Fulkerson JP. The plica syndrome: a new perspective. Orthop Clin North Am. Apr 1986;17(2):279-81. [Medline].

  3. Rovere GD, Adair DM. Medial synovial shelf plica syndrome. Treatment by intraplical steroid injection. Am J Sports Med. Nov-Dec 1985;13(6):382-6. [Medline].

  4. Brushøj C, Albrecht-Beste E, Bachmann M, Hölmich P. Acute patellofemoral pain: aggravating activities, clinical examination, MRI and US findings. Br J Sports Med. Jun 11 2007;epub ahead of print. [Medline].

  5. Dorchak JD, Barrack RL, Kneisl JS, Alexander AH. Arthroscopic treatment of symptomatic synovial plica of the knee. Long-term followup. Am J Sports Med. Sep-Oct 1991;19(5):503-7. [Medline].

  6. Gurbuz H, Calpur OU, Ozcan M, Kutoglu T, Mesut R. The synovial plicae in the knee joint. Saudi Med J. Dec 2006;27(12):1839-42. [Medline].

  7. Hardaker WT, Whipple TL, Bassett FH 3rd. Diagnosis and treatment of the plica syndrome of the knee. J Bone Joint Surg Am. Mar 1980;62(2):221-5. [Medline]. [Full Text].

  8. Kim SJ, Choe WS. Arthroscopic findings of the synovial plicae of the knee. Arthroscopy. Feb 1997;13(1):33-41. [Medline].

  9. Kim SJ, Shin SJ, Koo TY. Arch type pathologic suprapatellar plica. Arthroscopy. May 2001;17(5):536-8. [Medline].

  10. Lyu SR. Relationship of medial plica and medial femoral condyle during flexion. Clin Biomech (Bristol, Avon). Nov 2007;22(9):1013-6. [Medline].

  11. Patel D. Plica as a cause of anterior knee pain. Orthop Clin North Am. Apr 1986;17(2):273-7. [Medline].

  12. Uysal M, Asik M, Akpinar S, et al. Arthroscopic treatment of symptomatic type D medial plica. Int Orthop. Aug 28 2007;epub ahead of print. [Medline].

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Further Reading

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Keywords

suprapatellar plica, medial retinaculum

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Contributor Information and Disclosures

Author

Robert F LaPrade, MD, PhD, Professor, Department of Orthopaedic Surgery, Divisions of Sports Medicine and Shoulder Services, University of Minnesota
Robert F LaPrade, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Medical Editor

Anthony J Saglimbeni, MD, Staff Physician, Family Practice Residency, Medical Director, Center for Sports Medicine, O'Connor Hospital; Private Practice
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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