Chad Griffith, with the Department of Orthopaedic Surgery, University of Minnesota, says he believes 95 percent of people have a medial plica but only a small percentage of people will experience pain from their plica. Fewer will require surgery because most patients respond to a therapy program emphasizing hamstring stretching and quadriceps strengthening.
Anatomy
The medial plica is an in-folding of the joint capsule, which appears as a shelf-like band on the inside of the knee. The plica moves over the rounded end of the thigh bone as the knee flexes and extends. In patients with a thickened plica, the cartilage covering the medial end of the femur can erode. Other in-foldings of the knee joint capsule exist, such as the lateral plica. Usually only the medial plica requires surgery.
Symptoms
Medial plica might become painful after trauma or repetitive activity. (Reference 3) Some patients have knee joint swelling. Patients feel their knees catch or snap with bent knee activities such as squatting or stair climbing. The pain is dull and becomes worse with activity.
University of Minnesota doctors diagnose medial patella plica using a snap test. The physician feels the plica between the inside of the kneecap and the thigh bone. As the doctor moves her hand over the plica, she can feel it roll under her fingers. When the plica is inflamed, the patient will feel pain during this test.
Surgery
Patients will be given anesthesia to numb the leg or will be given general anesthesia. Using small incisions, the surgeon puts a arthroscopic camera into the knee. Special instruments are used to cut the plica. According to a research paper titled "Synovial Plicae Around the Knee," complete removal of the plica is recommended so the ailment does not recur. Dr. Chad Griffith writes that the surgeon will treat meniscal tears or arthritis that he finds during plica surgery.
Complications
The American Academy of Orthopaedic Surgeons lists infection, blood clots in the leg and complications from anesthesia as potential complications of arthroscopic surgery. According to "Synovial Plicae Around the Knee," resection of the plica can result in bleeding into the joint, and reformation of a scarred plica when removal of the plica is incomplete.
Recovery
For the first few days after knee arthroscopy, the American Academy of Orthopedic Surgeons recommends patients elevate and ice their knee. Patients should use crutches and pain medication as directed by their surgeon. As patients recover, therapeutic exercises might be recommended to strengthen the quadriceps and stretch the hamstring muscles.
References
- University of Minnesota Orthopaedics: Sports Medicine Institute: Knee Exam
- "Current Reviews Musculoskeletal Medicine": Medial Plica Irritation: Diagnosis and Treatment; Chad J. Griffith, Robert F. LaPrade; 2008
- "Synovial Plicae Around the Knee"; M. Kent, V. Khanduja: 2010
- American Academy of Orthopaedic Surgeons: Your Orthopaedic Connection: Knee Arthroscopy
