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Plica Syndrome: Causes, Symptoms & Treatment

Plica syndrome is an irritation of the synovial fold inside the knee joint. It causes pain, swelling, and snapping sensations and is common in physically active individuals.

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Things worth knowing about "Plica Syndrome"

Plica syndrome is an irritation of the synovial fold inside the knee joint. It causes pain, swelling, and snapping sensations and is common in physically active individuals.

What is Plica Syndrome?

Plica syndrome refers to the irritation or inflammation of the synovial plica – a fold of the synovial membrane inside the knee joint. This fold is an embryological remnant from fetal development, when the knee joint was divided into separate compartments. While it typically reabsorbs before birth, it persists in approximately 50 % of the population in varying forms. When irritated by overuse or injury, it can become thickened and inflamed, leading to pain and dysfunction.

Causes

Plica syndrome is most commonly caused by repetitive mechanical stress or direct trauma to the knee. Common triggering factors include:

Repetitive sports activities such as running, cycling, or squatting
Direct trauma or impact to the knee
A sudden increase in training intensity or volume
Weakness or muscular imbalances of the thigh muscles
Anatomical variations in the structure of the knee joint

Symptoms

The symptoms of plica syndrome can closely resemble those of other knee conditions, making diagnosis challenging. Common symptoms include:

Pain along the inner side of the knee, often around the kneecap (patella)
Snapping or clicking sensations during bending and straightening of the knee
Swelling and tenderness in the affected area
Stiffness of the knee joint, particularly after prolonged sitting
Increased pain when climbing stairs, squatting, or during physical activity

Diagnosis

Diagnosis of plica syndrome is primarily clinical, based on a thorough physical examination. The physician assesses pain location and may perform the plica test, in which the patella is pressed medially with the knee slightly flexed. Additional diagnostic tools include:

MRI (Magnetic Resonance Imaging): To visualize the plica and rule out other knee pathologies
Ultrasound: May reveal a thickened or inflamed plica
Arthroscopy: Considered the gold standard for direct visualization and simultaneous treatment of the plica

Treatment

Conservative Treatment

Most cases of plica syndrome can be successfully managed without surgery. Conservative treatment options include:

Rest and activity modification: Avoiding painful movements and reducing overload
Physical therapy: Strengthening exercises for the quadriceps and surrounding muscles, along with stretching and stabilization training
Anti-inflammatory medications (NSAIDs): Such as ibuprofen or diclofenac to relieve pain and inflammation
Ice application: To reduce swelling and discomfort
Corticosteroid injections: A local injection into the knee joint may provide relief in persistent cases

Surgical Treatment

If conservative measures fail to provide sufficient improvement after several weeks to months, arthroscopic resection of the plica may be recommended. This minimally invasive procedure typically carries a good prognosis and high success rate.

Prognosis

With early treatment and consistent rehabilitation, most patients recover fully. Recurrence can be prevented through targeted muscle training, proper warm-up routines before physical activity, and avoiding excessive overload of the knee joint.

References

Sznajderman T, Smorgick Y, Lindner D, et al. - Medial plica syndrome. Isr Med Assoc J. 2009;11(1):54-57.
Schindler OS - The surgical treatment of symptomatic medial plica of the knee. J Bone Joint Surg Br. 2009;91(8):1022-1028. DOI: 10.1302/0301-620X.91B8.22018
Lyu SR - Relationship of medial plica and medial femoral condyle during flexion. Clin Biomech. 1999;14(7):489-493.

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