Medial Synovial Plica Irritation Workup

  • Author: Robert F LaPrade, MD, PhD; Chief Editor: Craig C Young, MD   more...
 
Updated: Mar 5, 2012
 

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 the images below.

Medial plica of left knee. Medial plica of left knee. Patella in a male patient, medial aspect. Patella in a male patient, medial aspect.

See also Knee Osteochondritis Dissecans, Medial Compartment Arthritis, and Osteochondritis Dissecans.

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). However, the plica can rest flat against the synovium and capsule, causing an MRI appearance of normal synovium. Large synovial effusions separate the plica from the synovial membrane and make diagnosis on MRI easier.

Recent studies that investigated the use of dynamic ultrasonography to diagnose symptomatic plicae in the knee have reported good sensitivity and specificity.[4]

Next

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.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Robert F LaPrade, MD, PhD  Complex Knee Surgeon, The Steadman Clinic, Vail, Colorado; Director, Biomechanics Research Department, Steadman Philippon Research Institute, The Steadman Clinic

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.

Specialty Editor Board

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 and Santa Clara County Medical Association

Disclosure: South Bay Sports and Preventive Medicine Associates, Inc Ownership interest Other

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

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, 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, Director of Primary Care Sports Medicine Fellowship, 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, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

  1. Bellary SS, Lynch G, Housman B, et al. Medial plica syndrome: A review of the literature. Clin Anat. Jan 3 2012;[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. Jan 2006;22(1):17-26. [Medline].

  4. Paczesny L, Kruczynski J. Medial plica syndrome of the knee: diagnosis with dynamic sonography. Radiology. May 2009;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. Sep-Oct 1990;18(5):466-9. [Medline].

  6. Broom MJ, Fulkerson JP. The plica syndrome: a new perspective. Orthop Clin North Am. Apr 1986;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. Jun 2010;18(6):769-76. [Medline].

  8. 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].

  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. Jun 11 2007;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. Sep-Oct 1991;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. Dec 2006;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. Mar 1980;62(2):221-5. [Medline]. [Full Text].

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

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

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

  16. Patel D. Plica as a cause of anterior knee pain. Orthop Clin North Am. Apr 1986;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. Jan 2009;11(1):54-7. [Medline].

  19. 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].

 
Previous
Next
 
Medial plica of left knee.
Patella in a male patient, medial aspect.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.