Medial Synovial Plica Irritation Follow-up
- Author: Robert F LaPrade, MD, PhD; Chief Editor: Craig C Young, MD more...
Return to Play
Patients/athletes may return to participation in sports based upon their symptoms. Athletes are recommended to start out slowly and observe how their knee reacts overnight, before advancing their workout/exercise regimen. This gradual progression is important to follow because plical irritation appears to involve some tissue inflammation, which may take hours to develop after activities. Usually, it is safe to say that if a patient does not have pain or swelling with an activity, that it is safe to continue or attempt to advance in that activity.
Complications
Nonoperative complications include continued medial synovial plical irritation, which over time could potentially lead to a fibrotic plica. The most common complication, which is a poorer result than a complication, is increased pain after surgical debridement due to increased scar-tissue formation after surgery. The best way to avoid these complications is to make sure that the patient is enrolled in an appropriate physical therapy or home exercise program.
Prevention
The best way to prevent continued medial synovial plical irritation is to avoid those activities that cause irritation and to address the problem that caused the plical irritation in the first place. Such prevention strategies would include surgery to address meniscal tears or cartilage flaps or enrollment in a proper physical therapy program for those with patellofemoral dysfunction.
Prognosis
The overall prognosis for most patients with medial synovial plical irritation is good. Most patients will respond to a physical therapy program within the first 6-8 weeks, with most of the other patients responding over the next few months. Surgical intervention for a medial synovial plica should be reserved for those patients in whom all other modalities previously described in this article have failed (see Treatment, Acute Phase, Rehabilitation Program and Other Treatment).
Education
Most patients need to be instructed in a home exercise program to address their underlying quadriceps weakness and hamstring tightness. In addition, many of these patients may have a recurrence of some symptoms over time. Patients need to be informed of this possibility and be instructed to work on a home exercise program first, before consulting their physician's office, because they can frequently have an alleviation of symptoms with their home exercise program.
Bellary SS, Lynch G, Housman B, et al. Medial plica syndrome: A review of the literature. Clin Anat. Jan 3 2012;[Medline].
Lino S. Normal arthroscopic findings in the knee joint in adult cadavers. J Jpn Orthop Assoc. 1939;14:467-523.
Lyu SR, Hsu CC. Medial plicae and degeneration of the medial femoral condyle. Arthroscopy. Jan 2006;22(1):17-26. [Medline].
Paczesny L, Kruczynski J. Medial plica syndrome of the knee: diagnosis with dynamic sonography. Radiology. May 2009;251(2):439-46. [Medline].
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].
Broom MJ, Fulkerson JP. The plica syndrome: a new perspective. Orthop Clin North Am. Apr 1986;17(2):279-81. [Medline].
Lyu SR, Chiang JK, Tseng CE. Medial plica in patients with knee osteoarthritis: a histomorphological study. Knee Surg Sports Traumatol Arthrosc. Jun 2010;18(6):769-76. [Medline].
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].
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].
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].
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].
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].
Kim SJ, Choe WS. Arthroscopic findings of the synovial plicae of the knee. Arthroscopy. Feb 1997;13(1):33-41. [Medline].
Kim SJ, Shin SJ, Koo TY. Arch type pathologic suprapatellar plica. Arthroscopy. May 2001;17(5):536-8. [Medline].
Lyu SR. Relationship of medial plica and medial femoral condyle during flexion. Clin Biomech (Bristol, Avon). Nov 2007;22(9):1013-6. [Medline].
Patel D. Plica as a cause of anterior knee pain. Orthop Clin North Am. Apr 1986;17(2):273-7. [Medline].
Sakakibara J. Arthroscopic study on Lino's band (plica synovialis is mediopatellaris). J Jpn Orthop Assoc. 1976;17:279-81.
Sznajderman T, Smorgick Y, Lindner D, Beer Y, Agar G. Medial plica syndrome. Isr Med Assoc J. Jan 2009;11(1):54-7. [Medline].
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].
Print
