Medial plica syndrome is a common knee condition that can cause discomfort and limit movement. This issue arises when a normal structure within the knee becomes irritated, leading to a range of symptoms.
Understanding Medial Plica Syndrome
A plica is a fold in the synovial tissue, the thin, slippery lining of the knee joint. These folds are remnants from early knee development. While most resorb before birth, some persist into adulthood, with the medial plica being the most commonly found and symptomatic.
The medial plica is located on the inner side of the kneecap, running from the lower part of the patella to the lower end of the thighbone. Normally, this structure is thin and flexible, allowing for smooth knee movement. However, when it becomes irritated, inflamed, or thickened, it can lead to medial plica syndrome.
Common Symptoms
Individuals with medial plica syndrome often experience pain on the inner side of the kneecap. This pain is typically described as an achy discomfort that intensifies with activity.
Patients may also report a distinct clicking, snapping, or popping sensation when bending or straightening their knee. The knee might feel like it is catching or giving way, creating a sense of instability. Tenderness to the touch along the inner kneecap area is often present, and sometimes, the inflamed plica itself may be felt as a tender band beneath the skin.
How Medial Plica Syndrome Develops
Medial plica syndrome often develops due to repetitive knee movements. Activities like cycling, running, and squatting, which involve repeated bending and straightening of the knee, can consistently stress the plica. This ongoing friction and impingement can lead to irritation and inflammation.
Direct trauma to the knee, such as a fall or impact, can also cause the plica to become inflamed and painful. A sudden increase in activity level or prolonged knee flexion can contribute to this condition. Additionally, muscle imbalances, particularly weakness in the quadriceps or tightness in the hamstrings, can place extra stress on the knee joint and indirectly irritate the plica.
Diagnosing the Condition
Diagnosis of medial plica syndrome typically begins with a physical examination by a healthcare professional. During this exam, the doctor will palpate the area around the kneecap for tenderness and may perform specific maneuvers, like the plica stutter test, designed to reproduce symptoms. These tests help assess plica involvement and rule out other potential causes of knee pain.
While X-rays are not useful for directly visualizing the plica, they are often performed to rule out other bone-related knee conditions. Magnetic Resonance Imaging (MRI) can sometimes show a thickened or inflamed plica, especially if there is fluid buildup in the joint. However, MRI is primarily used to exclude other knee problems that might present with similar symptoms, such as meniscal tears or cartilage damage, as the presence of a plica on an MRI does not always indicate it is symptomatic.
Treatment Options
Initial treatment for medial plica syndrome usually focuses on conservative, non-surgical approaches. Resting the knee and avoiding activities that worsen symptoms are important first steps to reduce irritation. Applying ice packs to the affected area helps alleviate pain and reduce inflammation. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often recommended to manage pain and swelling.
Physical therapy plays a central role in recovery, aiming to strengthen the quadriceps muscles to help stabilize the kneecap and control the plica. Exercises also focus on improving flexibility through stretching the hamstrings and other surrounding muscles. If conservative measures do not provide sufficient relief, a corticosteroid injection into the knee joint may reduce inflammation and pain, allowing more effective participation in physical therapy.
If conservative treatments fail to resolve symptoms after several weeks to months, surgical intervention may be an option. The most common procedure is an arthroscopic plica excision or resection. During this minimally invasive procedure, a surgeon makes small knee incisions to insert a camera and specialized instruments, then removes the inflamed or thickened medial plica. Recovery is generally quick, with many patients resuming normal activities within 6 to 12 weeks, and the procedure often provides significant symptom improvement.