Plica syndrome

Plica syndrome
Classification and external resources
ICD-9	727.83
eMedicine	article/1252011

Plica Syndrome (also known as Synovial Plica Syndrome) occurs when the plica (an extension of the protective synovial capsule of the knee) becomes irritated or inflamed.

Presentation and pathophysiology

This inflammation is typically caused by the plica being caught on the femur, or pinched between the femur and the patella. The most common location of plica tissue is along the medial (inside) side of the knee. The plica can tether the patella to the femur, be located between the femur and patella, or be located along the femoral condyle. If the plica tethers the patella to the femoral condyle, the symptoms may cause it to be mistaken for Patello-femoral Syndrome or ligamental plague. Because of this similarity in symptoms, Plica Syndrome is frequently misdiagnosed as Patello-femoral Syndrome. Diagnosis is often complicated by the thin structures of plicae, fenestrated septum or unfenestrated septum all being too fine to resolve well even in MRI.

The plica themselves are remnants of the fetal stage of development where the knee is divided into three compartments. The plica normally diminish in size during the second trimester of fetal development, as the three compartments develop into the synovial capsule. In adults, they normally exist as sleeves of tissue called synovial folds. The plica are usually harmless and unobtrusive; Plica Syndrome only occurs when the synovial capsule becomes irritated, which thickens the plica themselves (making them prone to irritation/inflammation, or being caught on the femur).

Finding the presence of a plica is impossible to nearly impossible through any external tests, including an MRI. Plica can be detected arthroscopically, and their existence can only be confirmed during surgery.

Treatment

Treatment for Plica Syndrome should focus on decreasing the inflammation of the synovial capsule. First, the care provider may prescribe a non-steroidal anti-inflammatory medication. Therapeutic exercise and modalities may also be used to treat the plica. Iontophoresis and phonophoresis have been utilized successfully against inflammation of the plica and the synovial capsule. Rehabilitative exercises should begin when inflammation and pain have decreased. Surgical removal of the plica of the affected knee may be necessary.

See also

• Knee
• Knee pain
• Patellofemoral pain syndrome
• Iliotibial band syndrome

External links

• Plica of the knee - the great mimic
• AthleticAdvisor
• About.com
• http://www.orthogate.org/patient-education/knee/plica-syndrome.html