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Plica Syndrome

Clinical Overview

Reviewed by Dr. Jack Farr

Plica syndrome refers to conditions associated with plical pain. A plica is a fold of the tissue lining of the knee joint, which is a remnant of early development. There may be several of these folds in normal knees. Of the four common plica, which may be in any normal knee, the plica that most commonly becomes symptomatic is the one on the inner (medial) aspect of the knee and thus called the “medial plica”. Normally, a plica is small and smooth. The plica may be present for years without symptoms until it is irritated or inflamed most commonly through overuse or direct impact injury. Once it becomes irritated, it may become thickened, causing pain and further inflammation. Think of it a biting the inside lining of your mouth, which causes local pain and swelling. After that, the area is prone to “rebiting”. In much the same way, once a plica becomes irritated it is more prone to further irritation unless treated.

Although plica syndrome does not usually damage the knee (rarely, a large plica can rub on the articular cartilage and cause wear), it can be a very painful nuisance. Diagnosing plica syndrome can be tricky, but treatment is straightforward.

Causes
Plica problems can occur suddenly (acute) or over a long period of time (chronic). A sudden injury—falling or hitting your knee on the dashboard in an automobile accident—can cause the medial plica to swell and become painful. Later, scarring and thickening of the plica can develop, producing continuing symptoms. Chronic plica problems develop when the medial plica is irritated by certain exercises that involve repeatedly bending and straightening the knee, such as biking or using a stair machine.
Risk Factors
Plicae are remnants of tissue pouches found in the early stages of fetal development. As the fetus develops, these pouches normally combine to form one large knee joint cavity. If this process is incomplete, plicae remain as folds or bands of tissue within the knee. Injury, chronic overuse, or inflammatory conditions are associated with development of this syndrome. Some doctors report that women develop plica syndrome more often than do men.

Last updated: Jan-01-09

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