Medial Synovial Plica Irritation Clinical Presentation

Updated: Jul 22, 2022
  • Author: Robert F LaPrade, MD, PhD; Chief Editor: Craig C Young, MD  more...
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Presentation

History

Medial suprapatellar plical irritation is a common finding in patients who present with complaints of anterior knee pain.

Symptoms include complaints of pain and stiffness over the anteromedial aspect of the knee upon arising from a prolonged sitting position, pain going up and/or down stairs, and pain with prolonged activity.

The symptoms often wax and wane over periods of time until the patient presents to a physician's office because of persistent irritation.

Prolonged flexion may increase the pain, and extension might relieve the pain.

Some patients may have had a previous arthroscopy for complaints of medial-sided knee pain without alleviation of their symptoms after the arthroscopy, regardless of whether they had some medial meniscus or medial compartment articular cartilage pathology addressed at the time of their arthroscopy. Such patients usually did not have physical therapy or participate in an exercise program either before or after this surgery.

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Physical Examination

The examiner can palpate the plica by rolling one's fingers along the tissue between the medial epicondyle and the medial border of the patella. The plica is most commonly palpated about 1-2 fingerbreadths medial to the medial edge of the patella.

Patient pain and irritation upon the examiner rolling the medial suprapatellar plica under his or her fingers is a classic finding on physical examination. The examiner should ascertain whether the elicited pain is due to palpation of this well-innervated area of the synovium or whether the examiner is producing the type of pain that the patient experiences with activities.

Three diagnostic tests have been described for medial plica syndrome. The first is the active extension test during which a patient is asked to make a quick extension movement (eg, kicking). A positive test result occurs when pain (due to tension on the plica from the quadriceps muscles) is elicited with rapid extension. The second test relies on flexion. From full extension, the knee is rapidly flexed to between 30 º and 60 º of knee flexion. As before, the test result is positive when a painful sensation (due to the plica stretching with eccentric contraction of the quadriceps muscle) is elicited. The third test for medial plica syndrome is known as the mediopatellar plica (MPP) test. The patient is placed in a supine position with the affected knee extended. The examiner applies force to the inferomedial portion of the patellofemoral joint whileflexing the knee to 90 º. A positive test result occurs when the patient reports pain relief as the knee goes into flexion.

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