Synovial Plica Syndrome explained

Synovial Plica Syndrome or simply Plica Syndrome

This is a condition relating to irritation, enlargement, or inflammation of the plica in the knee. Plica is a membrane in the lining of the knee-joint or continuation of the protective synovial capsule that divides the knee into separate sections during fetal development.

During the second trimester of fetal development, the plica in the fetus usually reduces in size, and does not cause any trouble when the child is born or even later. However, in some adults this membrane is more extrusive, especially in people who may have had injuries or multiple surgeries over the medial part of the knee. In such a case the medial synovial plica becomes thick & fibrotic and develops into a Plica Syndrome.

There are four plica synovial folds in the human body out of which only one, called the Medial Plica, leads to the Plica Syndrome. This plica joins the lower end of the kneecap to the lower end of the thighbone.

Causes

The main cause of the Plica Syndrome is irritation, inflammation, or enlargement of the plica in the knee. Overuse & bending of the knee makes it more susceptible to injury and inflammation, leading to this condition.An injury to the plica may result in thickening of the plica and its losing elasticity, resulting in pain & inflammation.

This condition may develop due to any of the following reasons:

1. Repetitive motions
2. Kneeling for long periods
3. Excessive exercises which put stress on the knee
4. Activities which involve repetitive straightening & bending of the knee, such as, running, jogging, kicking, jumping, biking, and more
5. An injured plica as a result of an accident
6. Direct injury to the knee while indulging in sports, such as, volleyball, soccer, football, and more

Signs and Symptoms

The main symptoms of a Plica Syndrome are:

1. Pain, especially while squatting, sitting, and kneeling
2. Tenderness
3. Catching, clicking, and locking of the knee
4. Snapping sensation
5. Swelling

Consultation

A General Physician or an Orthopedic Surgeon is the subject matter expert.

Tests and Investigations

The diagnosis of a Plica Syndrome commences with a history and physical examination, which helps the physician to find origin of the pain, as well as, feel the plica tissue band. X-rays and Magnetic Resonance Imaging (MRI) are not of much use to detect this condition.

However, they may help in diagnosis of other knee ailments, such as, tearing of the meniscus or ligaments of the knee, and are helpful in ruling out Plica Syndrome. A Computed Tomography (CT) Scan is beneficial in understanding if the plica has thickened.

The best method to detect and treat this condition is through an Arthroscopy.

This is a Minimally Intrusive Surgery that involves insertion of a small fiber-optic TV camera that gives the surgeon a clear picture of the knee-joint and helps in determining if the medial plica has any inflammation.

Treatment Modalities Available

With the aim to reduce inflammation of the plica, treatment of Plica Syndrome does not usually need surgery. Physicians recommend surgeries only when all other treatment modalities fail.

The treatment includes a guided Rehabilitation Program with a focus on strengthening of the quadriceps muscles, directly attached to the medial plica, as well as, avoiding activities which cause pain in this membrane.

Non-operative treatment:

The non-surgical treatment for Plica Syndrome includes:

1. Anti-inflammatory medications such as Ibuprofen or Aspirin
2. Application of ice-compression packs
3. Ice massage
4. Cortisone Injection into the plica
5. Therapeutic exercises under supervision of a physiotherapist
6. Ultrasound
7. Friction massage
8. Iontophoresis (the procedure of inserting anti-inflammatory medicines using mild electric current)

Operative treatment:

If all the above methods fail, then the physician may suggest an Arthroscopic Surgery to remove the plica. The surgeon uses an arthroscope to detect the plica and removes it by inserting small instruments. Gradually, scar tissues replace the void created by the plica.

Complication in Management

Non-surgical treatment may lead to: Continuous pain and/or clicking

Operative treatment may lead to:

1. Pain
2. Stiffness
3. Failure to improve

Rarely surgeries may also cause:

1. Bleeding
2. Infection
3. Nerve injury

Rehabilitation

Non-operative Rehabilitation:

Non-operative rehabilitation requires 4 to 6 weeks. Under a physiotherapist's guidance, the patient may indulge in strengthening and stretching exercises.

Surgical Rehabilitation:

Surgical rehabilitation includes keeping pain under control, increasing the strength of the muscles, and maximizing the range of motion. A physiotherapist suggests exercises, depending on the patient's condition.

Physical Activity Requirements

Patients suffering from Plica Syndrome should strictly avoid all activities that cause pain to the knee. Overuse, as well as straining the knee may aggravate the condition. Post-surgery, the patient needs to put the knee to rest for a few weeks before starting the Rehabilitation Program.

Prevention to Avoid Recurrence

It is important to take rest and to get back to daily activities, as well as, join back sporting activities only after full recovery. Also, proper padding reduces possibility of direct injury to knee.

Support from Family

Plica Syndrome is usually very painful. Hence, psychological support and assurance from the family members helps in faster recovery of the patient.