Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Medial Synovial Plica Irritation Treatment & Management

  • Author: Robert F LaPrade, MD, PhD; Chief Editor: Craig C Young, MD  more...
 
Updated: Mar 05, 2014
 

Acute Phase

Rehabilitation Program

Physical Therapy

The first mode of treatment for suprapatellar plical irritation of the knee is nonoperative.[5] All patients should have a program of physical therapy established for them, which includes closed-chain quadriceps kinetic exercises and a hamstring-stretching program. A closed-chain quadriceps exercise program should include the use of an exercise bike, leg presses, straight-leg raises (with and without leg weights), and the performance of mini-squats or use of a squat rack machine.

An important consideration to recognize is that patients who participate in open-chain quadriceps exercises, especially those who work on knee-extension exercises on a weight machine, often have an increase in their suprapatellar plical irritation.

In addition, patients should recognize that a hamstring-stretching program must be performed several times daily to maximize improvement. Approximately 50% of patients notice a significant improvement with an exercise program in the initial 6 weeks, with a larger percentage of the remaining patients improving with an additional 6 weeks of rehabilitation.

Recreational Therapy

Patients who have medial synovial plical irritation should avoid those activities that cause irritation of their knees until they note improvement with a physical therapy or home exercise program. Such precluding activities may include avoidance of stairs, squatting activities, or long-distance jogging or running.

Medical Issues/Complications

The most common complication associated with medial synovial plical irritation is continued pain or increased pain after surgery.[5, 6] For this reason, it is important to have exhausted all nonoperative forms of treatment for patients before any attempts at surgery.

Surgical Intervention

In patients who have exhausted all other means of therapy, an arthroscopic evaluation of the knee may be indicated. Because a debrided synovial plica results in alleviation of symptoms in only about 60-70% of cases, with some of the remaining patients actually having more pain after surgery, it is recommended that the synovial plica be debrided only if significant scar tissue is present in the plica or if shelf erosion is noted on the medial femoral condyle from a fibrotic plica.

Some practitioners advocate resection of asymptomatic medial plicae in patients with a coexisting knee pathology that requires surgical intervention.[7] This is based on the idea that removing a medial plica helps to prevent future complications; however, this has been a source of debate in the orthopedic field.[#TreatmentAcutePhaseConsultations]

Consultations

Any patient in whom conservative and/or surgical treatment protocol fails should have consultation with a subspecialist fellowship-trained orthopedic surgeon who deals with knee pathology.

Other Treatment

In patients who have persistent pain after a rehabilitation or home therapy program for synovial plical irritation, consideration should be given for a possible combined local anesthetic and corticosteroid injection to try and decrease some of the inflammation.[8]

Patients who undergo this injection need to recognize that their underlying quadriceps dysfunction and hamstring tightness still need to be addressed. After the injection, these individuals should either be enrolled in a physical therapy program or have a well-instituted home therapy program to maximize their chances for a good outcome.

Next

Maintenance Phase

Rehabilitation Program

Physical Therapy

Once a patient has recovered from medial synovial plical irritation, the individual needs to recognize that there is very likely a risk for the recurrence of symptoms if he or she does not participate in a maintenance rehabilitation program. Always recommend to these patients that they try to work on a routine exercise program indefinitely to minimize their chances of recurrence of their knee pain.

Previous
 
 
Contributor Information and Disclosures
Author

Robert F LaPrade, MD, PhD Complex Knee and Sports Medicine Surgeon, The Steadman Clinic; Chief Medical Research Officer, Steadman Philippon Research Institute; Co-Director, Sports Medicine Fellowship Program, Director, International Scholar Program, Adjunct Professor, Department of Orthopedic Surgery, University of Minnesota Medical School; Affiliate Faculty, College of Veterinary Medicine and Biomedical Sciences, Colorado State University

Robert F LaPrade, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, European Society for Sports Traumatology, Knee Surgery and Arthroscopy, International Cartilage Repair Society, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, 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

Disclosure: Nothing to disclose.

Additional Contributors

Anthony J Saglimbeni, MD President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College

Anthony J Saglimbeni, MD is a member of the following medical societies: California Medical Association, Santa Clara County Medical Association, Monterey County Medical Society

Disclosure: Received ownership interest from South Bay Sports and Preventive Medicine Associates, Inc for board membership.

References
  1. Bellary SS, Lynch G, Housman B, et al. Medial plica syndrome: A review of the literature. Clin Anat. 2012 Jan 3. [Medline].

  2. Lino S. Normal arthroscopic findings in the knee joint in adult cadavers. J Jpn Orthop Assoc. 1939. 14:467-523.

  3. Lyu SR, Hsu CC. Medial plicae and degeneration of the medial femoral condyle. Arthroscopy. 2006 Jan. 22(1):17-26. [Medline].

  4. Paczesny L, Kruczynski J. Medial plica syndrome of the knee: diagnosis with dynamic sonography. Radiology. 2009 May. 251(2):439-46. [Medline].

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

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

  7. Lyu SR, Chiang JK, Tseng CE. Medial plica in patients with knee osteoarthritis: a histomorphological study. Knee Surg Sports Traumatol Arthrosc. 2010 Jun. 18(6):769-76. [Medline].

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

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

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

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

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

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

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

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

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

  17. Sakakibara J. Arthroscopic study on Lino’s band (plica synovialis is mediopatellaris). J Jpn Orthop Assoc. 1976. 17:279-81.

  18. Sznajderman T, Smorgick Y, Lindner D, Beer Y, Agar G. Medial plica syndrome. Isr Med Assoc J. 2009 Jan. 11(1):54-7. [Medline].

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

 
Previous
Next
 
Medial plica of left knee.
Patella in a male patient, medial aspect.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.