Plica Syndrome
Encyclopedia
Plica Syndrome occurs when the plica (an extension of the protective synovial capsule
of the knee) becomes irritated or inflamed.
, 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.
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.
Joint capsule
An articular capsule is an envelope surrounding a synovial joint.-Layers:Each capsule consists of two layers:* an outer layer composed of avascular white fibrous tissue...
of the knee) becomes irritated or inflamed.
Presentation and pathophysiology
This inflammation is typically caused by the plica being caught on the femurFemur
The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
, or pinched between the femur and the patella. The most common location of plica tissue is along the medial (inside) side of the knee
Knee
The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...
. 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
Chondromalacia patellae
Chondromalacia patellae is a term that goes back eighty years. It originally meant "soft cartilage under the knee cap," a presumed cause of pain at the front and especially inner side of the knee. This condition often affects young, otherwise healthy individuals.Chondromalacia is due to an...
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. IontophoresisIontophoresis
Iontophoresis is a technique using a small electric charge to deliver a medicine or other chemical through the skin. It is basically an injection without the needle...
and phonophoresis
Phonophoresis
Phonophoresis is the use of ultrasound to enhance the delivery of topically applied drugs. Phonophoresis has been used in an effort to enhance the absorption of topically applied analgesics and anti-inflammatory agents through the therapeutic application of ultrasound.Phonophoresis has been shown...
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
- KneeKneeThe knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...
- Knee painKnee painKnee pain is a common complaint for many people. There are several factors that can cause knee pain. Awareness and knowledge of knee pain causes lead to faster diagnosis and treatment. Knee pain can be related to knee joint or around the knee.-Knee joint:...
- Patellofemoral pain syndrome
- Iliotibial band syndromeIliotibial band syndromeIliotibial band syndrome is a common injury to the thigh, generally associated with running, cycling, hiking or weight-lifting .- Definition :...
External links
- Plica of the knee - the great mimic
- AthleticAdvisor
- About.com
- http://www.orthogate.org/patient-education/knee/plica-syndrome.html