Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Dec 5;90(12-S):33-38.
doi: 10.23750/abm.v90i11-S.8781.

Management of suprapatellar synovial plica, a common cause of anterior knee pain: a clinical review

Hassan Zmerly  1 , Manuela Moscato, Ibrahim Akkawi
Affiliations
Review

Management of suprapatellar synovial plica, a common cause of anterior knee pain: a clinical review

Hassan Zmerly et al. Acta Biomed. .

Abstract

Background and aim of the work: Suprapatellar synovial plica is caused by a congenital thickening of the synovial membrane and is generally asymptomatic. In the literature, suprapatellar plicae are described as one of the causes of anterior knee pain however, their real role in determining symptoms is controversial. The aim of the current paper is to describe the anatomy, classifications, pathophysiology, symptoms and management of suprapatellar plica syndrome, as well as the differential diagnosis from other causes of anterior knee pain.

Method: Via a search within the MEDLINE/PubMed database, a current review was conducted, and the results summarized.

Results: Due to idiopathic, traumatic or inflammatory conditions, plicae can become pathological, causing anterior knee pain with possible knee clicking, swelling, giving way and locking after prolonged flexion of the knee. The diagnosis should be formulated based on an accurate medical history and clinical examination, followed by an appropriate imaging study. However, arthroscopy remains the "golden standard" for detecting all synovial plica.

Conclusions: In patients with anterior knee pain, where doubt is present in the imaging investigation for intraarticular or periarticular lesions, pathological suprapatellar synovial plica must be suspected. The treatment should initially be conservative, but in cases where symptoms persist, patients should undergo arthroscopy to confirm diagnosis and to determine a suitable treatment. In the presence of pathological plica associated with cartilage damage of the femoral condyle or patella at the time of diagnostic arthroscopy, plicae excision leads to favourable results in a high number of cases.

PubMed Disclaimer

Conflict of interest statement

Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article

Figures

Figure 1.
Figure 1.
Suprapatellar synovial plica of the complete septum type situated above the superior patella pole
Figure 2.
Figure 2.
Perforated suprapatellar plicae with central small hole associated with the physiopathological hydraulic mechanism based on Pipkin’s theory
Figure 3.
Figure 3.
MRI of pathologic suprapatellar synovial plica
Figure 4.
Figure 4.
Pathological arcuate type of plica, associated with fibrosis, thickening of the border and abnormal size
See this image and copyright information in PMC

References

    1. Patel D. Arthroscopy of the plicae: synovial folds and their significance. Am J Sports Med. 1978;6:217–225. - PubMed
    1. Schindler OS. ‘The Sneaky Plica’ revisited: morphology, pathophysiology and treatment of synovial plicae of the knee. Knee Surg Sports Traumatol Arthrosc. 2014;22(2):247–262. - PubMed
    1. Zmerly H, Akkawi I, Citarella R, El Ghoch M. Clinical Management of Medial Patellar Plica Syndrome: Expert Point of View from Diagnosis to Treatment. Curr Rheumatol Rev. 2018 - PubMed
    1. Patel D. Plica as a cause of anterior knee pain. Orthop Clin North Am. 1986;17:273–7. - PubMed
    1. Akao M, Ikemoto T, Takata T, Kitamoto K, Deie M. Suprapatellar plica classification and suprapatellar plica syndrome. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2019;17:10–15. - PMC - PubMed