We commonly see patients who wonder if they might have a plica in their knee that is causing anterior knee pain. Knee Plica Syndrome is a commonly diagnosed but an often poorly understood condition. In this post we aim to demystify it; explain what it is, describe the tests that may be needed to diagnose it, and outline the treatment options available to you.
What is a knee plica?
The knee joint is surrounded by a sort of balloon of tissue that is thin and leathery. This is known as the capsule.
The lining of the capsule is covered by specialist tissue called Synovium. The synovium is very important for the function of the joint, amongst other things it is responsible for making the joint fluid that is present in normal knees. Plica are folds of synovium.
They are present in normal knees, and are normally thin, pliable and almost transparent. In the normal knee they glide painlessly across the surfaces of the knee as it bends.
What sort of symptoms might I get from a knee plica?
Patients often will describe anterior knee pain, most commonly on the medial part of the knee (next to the knee cap, close to the midline of the body).
There might be clicking, clunking and popping when the knee is bending and weight is going through it. Often symptoms will be worse when doing activities such as squats, lunges, running, or going up and down stairs. Commonly, it can be painful enough to stop people exercising.
Why doesn’t everyone get symptoms from their knee plica?
Plica are normal anatomical structures and when in their normal state they glide painlessly across the joint surface of the knee. When an injury occurs to the knee, or changes occur to the biomechanics of the movements around the knee, the plica can become inflamed, thickened and stiff.
This means that instead of gliding across the joint surfaces they can catch and rub, becoming painful. Often patients describe a recent sudden increase in activity, or performing activities that can cause a muscle imbalance around the knee. In many cases, no clear cause is identified.
Diagnosis of Knee Plica Syndrome
The first step to diagnosing Knee Plica Syndrome is a thorough history and then clinical examination. This will allow other causes of anterior knee pain and catching to be considered and ruled in or out.
Often, dynamic ultrasound scans or an MRI scan are used to identify a thickened plica.
Treatment options for knee place syndrome
At Grosvenor Orthopaedic Partners we always try to manage knee symptoms with non-operative strategies in the first instance, as with all knee conditions.
These include activity modification, analgesia and physiotherapy to rectify any abnormal lower limb biomechanics or imbalances.
Ultrasound guided injections ot the plica can help confirm the diagnosis and also reduce inflammation, acting as an adjunct to physiotherapy. In refractory cases, keyhole surgery to the knee with gentle surgical resection of the thickened plica can often be helpful.
If you have any questions about Knee Plica Syndrome or knee pain, please contact our team to arrange an initial consultation.