Medial plica irritation: diagnosis and treatment

Abstract

Medial plica irritation of the knee is a very common source of anterior knee pain. Patients can complain of pain over the anteromedial aspect of their knees and describe episodes of crepitation, catching, and pseudo-locking events with activities. Patients commonly have pain on physical examination upon rolling the plica fold of tissue over the anteromedial aspect of their knees and often have tight hamstrings. The majority of the patients will respond well to a non-operative treatment program consisting of quadriceps strengthening along with concurrent hamstring stretching. In cases which do not respond initially to an exercise program, an intraarticular steroid injection may be indicated. In those few patients who do not respond to a non-operative treatment program, an arthroscopic resection of their medial plica may be indicated, especially in those cases where a shelf-like plica has been found to be causing damage to the articular cartilage of the medial femoral condyle.

Fig. 1

Intraoperative visualization of medial synovial plica

Fig. 2

Medial synovial plica palpation (Plica snap test)

Fig. 3

Palpation of meniscofemoral portion of superficial medial collateral ligament while applying valgus stress at 30° of knee flexion

Fig. 4

Lateral translation of patella

Fig. 5

Proximal and distal translation of superior and inferior poles of patella within trochlear groove. (a) Proximal translation (b) Distal translation

Fig. 6

Assessment for patellofemoral joint crepitation during active range of motion. (a) Extension (b) Flexion

Fig. 7

Hamstring-popliteal angle

Fig. 8

Palpation of pes anserine bursae

Fig. 9

Palpation of semimembranosus bursae

Fig. 10

Palpation of biceps femoris bursae

Fig. 11

Intraarticular injection of 1% Lidocaine

Fig. 12

Quadriceps set exercise

Fig. 13

Straight leg raise exercise

Fig. 14

Leg press exercise

Fig. 15

Stationary bike exercise

Fig. 16

Leg extension exercise

Fig. 17

Hamstring stretching