Patient Education:     Synovial Plica Syndrome

                                   

Orthopaedic Sports Medicine Center

4865 North McColl Rd.

McAllen, TX 78504

Phone: (956) 994-8983

 



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This material has been provided by the physician as an educational tool and is not meant to take the place of professional care. Please consult your doctor for any questions, concerns or changes in your condition.


What is plica syndrome?

Plica syndrome is a problem that occurs when an otherwise normal structure in the knee becomes a source of knee pain due to injury or overuse. The diagnosis can sometimes be difficult, but if this is the source of your knee pain, it can be easily treated.


What is a synovial plica?

The synovial plica are membranes that separate the knee into compartments during fetal development. These plica normally diminish in size during the second trimester of fetal development. In adults, they exist as sleeves of tissue called "synovial folds," or plica. In some individuals, the synovial plica is more prominent and prone to irritation.

How does a plica cause problems in the knee?

A plica causes problems when it is irritated. This can occur over a long period of time, such as when the plica is irritated by certain exercises, repetitive motions, or kneeling. Activities that repeatedly bend and straighten the knee, such as running, biking, or use of a stair-climbing machine, can irritate the medial plica and cause plica syndrome.

Injury to the plica can also happen suddenly, such as when the knee is struck in the area around the medial plica. This can occur from a fall or even from hitting the knee on the dashboard during an automobile accident. This injury to the knee can cause the plica, and the synovial tissue around the plica, to swell and become painful. The initial injury may lead to scarring and thickening of the plica tissue later. The thickened, scarred plica fold may be more likely to cause problems later.


What are the symptoms of plica syndrome?

The primary symptom caused by plica syndrome is pain. There may also be a snapping sensation along the inside of the knee as the knee is bent. This is due to the rubbing of the thickened plica over the round edge of the thighbone where it enters the joint. This usually causes the plica to be tender to the touch. In thin people, the tissue that forms the plica may actually be felt as a tender band underneath the skin. In some cases where the plica has become severely irritated, the knee may become swollen.


What can be done for plica syndrome?

The majority of people with plica syndrome will get better without surgery. The primary goal when treating the plica is to reduce the inflammation. This may require limiting activities like running, biking, or using a stair-climbing machine.


   >Nonsurgical Treatment

Your doctor may suggest anti-inflammatory medications such as ibuprofen or aspirin to reduce the inflammation. Ice packs or ice massage can help reduce the inflammation and swelling in the area of the plica and may be suggested by your doctor or physical therapist. Ice massage is easy and effective. Simply freeze water in a paper cup. When needed, tear off the top inch, exposing the ice. Rub three to five minutes around the sore area until it feels numb. Wearing proper shoe wear with arch support is an important key that your doctor may suggest because it improves overall biomechanics which decreases the overall stress you put on your knees.

A cortisone injection into the plica, or simply into the knee joint, may quickly help to reduce the inflammation around the plica. Cortisone is a powerful anti-inflammatory medication, but it should be used sparingly inside joints. There is always a risk of infection associated with injections into any joint.

    

>Surgery

If all nonsurgical attempts to reduce your symptoms fail, surgery may be suggested. Usually, an arthroscope (mentioned earlier) is used to remove the plica. The small TV camera is inserted into the knee joint through one-quarter inch incisions. Once the plica is located with the arthroscope, small instruments are inserted through another one-quarter inch incision to cut away the plica tissue and remove the structure. The area where the plica is removed heals back with scar tissue. There are no known problems associated with not having a plica, so you won't miss it.