Plica Syndrome

From Shankman GA: Fundamental Orthopaedic Management
for the Physical Therapy Assistant. St. Louis, Mosby Year Book, 1997, p. 141.

Description
The plica is a fold of joint lining (synovial tissue) that is a remnant of tissue from embryologic development. During embryologic development, bands of tissue divide the limbs into joints. These bands may persist into adulthood in up to 60% of people, although it infrequently causes symptoms. Several different band types may exist. These bands may become thickened and inflamed, causing varying symptoms.

Common Signs and Symptoms – Notify a physician if these symptoms do not resolve.

Pain in the front of the knee, often toward the inside of the knee, especially with kneeling, squatting, sitting for long periods, arising from a sitting position or walking or running up or down stairs or hills
Catching, locking and clicking of the knee
Pain and tenderness under the kneecap (patella)

Treatment
Initial treatment consists of ice to relieve pain and reduce inflammation, stretching and strengthening exercises (of the hamstrings and quadriceps), and modification of the activity that produces the symptoms. These may be carried out at home, although occasionally referral to a physical therapist or athletic trainer may be indicated. Occasionally, your physician may recommend an injection of cortisone to reduce the inflammation of the plica. Arch supports may also be recommended. Surgery is not usually necessary; it is usually reserved for cases in which symptoms persist despite conservative treatment. Surgery to remove the plica is usually performed arthroscopically on an outpatient basis (you go home the same day).

RICE Principle
With all acute injuries, follow the RICE principle to reduce swelling, pain and inflammation.

Rest- Avoid activities that irritate the injury while the plica is inflamed.
Ice- Use an ice pack after any type of activity for 20 minutes and when knee is swollen.
Compression- An ace wrap or neoprene sleeve on the knee may provide additional comfort during activity.
Elevation- Keep the leg elevated when the knee is swollen