Plica syndrome is a cause of anterior knee pain that occurs when a normal anatomical structure inside the knee joint becomes inflamed. For individuals experiencing persistent discomfort that resists conservative treatments, the question of whether to proceed with plica surgery becomes relevant. The decision to undergo arthroscopic resection requires evaluating the procedure’s mechanics, the commitment to rehabilitation, and the documented success rates. Weighing the potential for symptom relief against the risks and recovery time determines if surgery is the right choice.
Understanding Plica Syndrome
Plicae are shelf-like folds of the synovial membrane lining the knee joint. These folds are remnants of the knee’s development in utero. While four plicae exist, the medial plica, located on the inner side of the kneecap, is the one most commonly associated with irritation and pain.
Plica syndrome develops when this tissue fold becomes thickened, stiff, or fibrotic, usually due to repetitive motion, overuse, or direct trauma. The thickened plica can impinge or rub against the medial femoral condyle, particularly during knee flexion between 70 and 100 degrees. This mechanical irritation causes symptoms like anterior knee pain, a clicking or snapping sensation, and sometimes a feeling of the knee catching. Diagnosis relies on a physical examination and the exclusion of other knee conditions, as the plica is difficult to definitively visualize with standard imaging like MRI.
Non-Surgical Management Options
Initial management focuses on reducing inflammation and addressing underlying biomechanical issues. Patients are advised to modify activities that aggravate the knee, such as deep squats or repetitive bending, and to use ice therapy to manage swelling. Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed to decrease pain and inflammation within the joint capsule.
Physical therapy is a core component of conservative treatment, focusing on exercises to strengthen the quadriceps muscle, which helps stabilize the kneecap. Stretching protocols for tight hamstrings and the iliotibial band are also incorporated, as tightness in these areas can increase stress on the knee. If symptoms persist despite several weeks of medication and therapy, a corticosteroid injection may provide temporary relief from inflammation, allowing the patient to better participate in rehabilitation. Surgery is reserved as a last resort, recommended only after a dedicated trial of conservative treatment, usually lasting 3 to 6 months, has failed to resolve symptoms.
The Surgical Procedure and Immediate Recovery
The definitive surgical treatment is arthroscopic plica resection, a minimally invasive procedure. The surgeon makes small incisions to insert a camera (arthroscope) and specialized instruments into the knee joint. The inflamed and thickened plica tissue is removed, relieving the mechanical rubbing and impingement.
This procedure is often performed on an outpatient basis, meaning most patients return home the same day. Immediate post-operative care centers on pain management using prescribed narcotic and non-narcotic medication, alongside the consistent use of ice and elevation to control swelling. Patients are encouraged to begin immediate activity, such as ankle pumps and gentle range-of-motion exercises, within 24 hours of surgery.
Initial mobility is supported by crutches, which may be needed for an average of 10 days, though this varies based on individual pain and the surgeon’s protocol. The first phase of rehabilitation, typically the first two weeks, aims to restore full knee extension and achieve at least 90 to 120 degrees of flexion. The second phase focuses on progressive strengthening exercises. Overall recovery to return to normal daily activities often occurs within 4 to 6 weeks.
Assessing Long-Term Outcomes
For patients who have failed conservative management, plica resection is generally a successful intervention, with reported success rates for symptom resolution ranging from 80% to over 95%. The success of the procedure is influenced by the accuracy of the initial diagnosis, ensuring the plica was the primary source of pain. Patients typically experience improvement in functional scores and quality of life within three to six months following the operation.
Optimal long-term results depend heavily on adherence to the post-operative physical therapy program. Coexisting cartilage lesions can negatively affect the final outcome, as plica syndrome may have caused minor joint surface damage. While complications are uncommon, potential risks include persistent pain, joint stiffness, and recurrent synovitis or nerve injury. The need for long-term rehabilitation extending beyond six months affects a small percentage of patients, typically around 5%.