Dear Nick.
I have 'seen' some of these in my years working with footballers and also
with icehockey players. You should be able to palpate plicae in quite a few
of your patients even though they are asymptomatic. I found they mostly
become a problem after contact injuries, but if diagnosed early, will
settle nicely with ice, rest and NSAID. Rarely do they need the attention
of the orthopaedic surgeon.
I did a quick search and found the following abstracts that might be of
interest.
Torje Eike, MCSP, PT
Chartered Physiotherapist
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Symptomatic Synovial Plicae of the Knee.
Johnson-David-P. Eastwood-Deborah-M. Witherow-Peter-J.
The Journal of Bone and Joint Surgery (American Volume). 1993 Oct.
75-A(10). pp 1485-1496.
ABSTRACT: Forty-five knees (thirty patients) with a specific diagnosis of
synovial plica syndrome, and without any other known lesion, were
randomized to be treated with either diagnostic arthroscopy alone or
arthroscopy and division of all plicae. The diagnosis of synovial plica
syndrome had been made on the basis of intermittent pain in the anterior
aspect of the knee, painful
clicking with activity, giving-way, and a palpable, tender plica. The
patients were selected for arthroscopy only if the symptoms had continued
unabated after a course of physical therapy. At the time of follow-up,
improvement had occurred in only six (29 per cent) of the twenty-one knees
in which the plicae had not been divided, in contrast with twenty (83 per
cent) of the twenty-four knees in which they had been divided (p < 0.001).
Ten (48 per cent) of the knees in which arthroscopic division had not been
done were treated with another arthroscopic operation. Seven of these ten
knees improved after the subsequent division of the plicae
(p < 0.01). We concluded that synovial plicae of the knee may be a
definite cause of anterior pain in children and adolescents.
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Medial Plica (Shelf Plica)
- Discussion:
- most common form of plica;
- located over the medial femoral condyle;
- vulnerable to direct trauma when the knee is flexed;
- repeated trauma or irritation may lead to inflammation and fibrosis
of the plica;
- fibrotic plica has decreased elasticity which causes it to
impinge on
either the patella or the femoral condyle;
- Clinical Manifestations: (Medial Plica)
- diagnosis of symptomatic plica is made by exclusion; and presence of
a plica
by itself, does not connote pathology;
- symptoms may mimic those of a torn meniscus (eg. snapping, clicking,
&
medial joint line tenderness;
- anterior knee tenderness may be attributed to the anteiror extension
of the plica
to the fat pad;
- when thickened, the medial plicae may be palpated just above the
joint line;
- palpation of the plica may be facilitated by having the
patient flex & extend
knee while the surgeon palpates the medial condyle next
to patella;
- Treatment:
- symptomatic plicae are managed with rest & NSAIDS;
- excision, while rarely indicated, is very effective when necessary;
- Arthroscopic Treatment: (knee arthroscopy);
- position for arthroscopic visualization:
- knee is extended;
- joint is repeatedly flexed to check for impingement of
medio-patellar plica
on the medial femoral condyle or patella;
- normal findings:
- it runs along medial capsular wall between infrapatellar fat
pad and the
medial capsule, hence dividing wall into a superior and
inferior portion;
- pathologic plica:
- look for thickened shelf that impinges on medial femoral
condyle or patella during flexion;
- also look for evidence of femoral condylar cartilage damage
from the plica;
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Arthroscopic Findings of the Synovial Plicae of the Knee
Sung-Jae Kim, M.D., and Wahn-Sub Choe, M.D.
Summary: From June 1991 to March 1993, 400 knees in 363 patients were
studied arthroscopically to clarify the arthroscopic anatomy of the plica
and determine the classification of the plica. The various patterns of the
synovial plicae were classified according to their shape and size from the
arthroscopic view. Incidences of the synovial plica at the knees were:
suprapatellar plica, 87.0%; mediopatellar plica, 72.0%; infrapatellar
plica, 86.0%; and lateral patellar plica, 1.3%. There was no significant
correlation in frequencies and distributions of patterns among the four
groups of the plica, between men and women, with age, and between right and
left. However the significant similarity in patterns of the right and left
knees in the same persons was noted. Key Words: Knee--Synovial plica--Plica
syndrome--Arthroscopy.
Address correspondence and reprint requests to Sung-Jae Kim, M.D.,
Department of Orthopaedic Surgery, Yonsei University College of Medicine,
134 Shin-Chon, Seo-Dae-Moon, Seoul, CPO Box 8044, Korea.
Copyright © 1997 Arthroscopy Association of North America
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