Medial Plica Syndrome
The medial plica syndrome is an orthopaedic condition characterized by a cleft in the cartilage of the lower portion of the thoracic spine. It is most often caused by an injury or an underlying disease, such as spinal stenosis, and can be treated by Arthroscopic surgery. However, MRI scans are not very reliable in determining whether a person suffers from the syndrome. Therefore, the diagnosis is usually made after symptoms appear.
Symptoms
Medial plica syndrome is an ailment of the knee. It is usually associated with a series of symptoms including pain, swelling, instability and effusion. The exact cause of plica syndrome is not known, but it can be caused by a variety of factors.
Most cases of plica syndrome resolve with conservative treatment. These treatments include rest, anti-inflammatory medicines and physiotherapy. However, if the symptoms continue, surgery may be necessary.
During a physical examination, your doctor will try to find out where the pain is, as well as whether or not a band of tissue is present. This can be done through a flexion test. In this test, you swing your tibia from full extension to flexion. If you feel a pop, you have a medial plica.
An MRI is an alternative to an X-ray to diagnose plica syndrome. Using a small camera, your doctor can look inside the knee to assess the soft tissues. Unlike X-rays, MRI does not require special dye.
A CAT scan is another diagnostic test used to check for a thickened plica fold. If a plica is thick, it may not be able to flex properly and could cause problems later.
Surgery to remove a plica is only recommended if other treatments fail. Usually, patients can return to their normal activities as soon as the surgery is performed.
Symptoms of plica syndrome can be relieved with exercise and anti-inflammatory medicines. Exercise can help reduce inflammation and improve the strength of the quadriceps muscles. Some people can also get relief from ice massage.
Physical therapy can also be effective in treating plica syndrome. During a physical therapy session, your therapist will work to increase your range of motion. Additionally, he or she will focus on strengthening your calf, hamstring and quadriceps muscles.
Diagnosis
If you are experiencing pain at the front of your knee, you may be suffering from medial plica syndrome. This condition causes irritation and inflammation of the medial patellar area. It is characterized by intermittent, dull aching pain that is usually accompanied by stiffness and locking of the joint.
Although some cases of plica syndrome can be treated conservatively, some patients require arthroscopy for definitive treatment. However, this procedure can have complications, including scarring of the plica. There are alternative treatments for this condition, including physiotherapy and rest.
The initial management of plica syndrome involves anti-inflammatory agents, rest, and gentle exercises to rehabilitate the knee. Most people have relief within six to eight weeks. Physical therapy can also help regain strength and range of motion.
Treatment can include strengthening the quadriceps and hamstrings muscles. Cryotherapy can also be used for pain relief.
If plica syndrome is suspected, imaging is done to exclude other conditions. X-rays or CAT scans can be used to determine the thickness of the plica. An MRI can be helpful to show the size and shape of the plica.
Medial plica syndrome can be aggravated by overuse and trauma to the knee. Repetitive bending and straightening of the knee, as well as catching, can cause plica irritation. These symptoms are nonspecific and may be similar to those of other knee disorders.
A patella instability test is positive if the examiner is able to glide the patella medially. When the patella is extended to 90 degrees, it may produce a popping sound. In some cases, this test is falsely positive.
The McMurray test is another test that can be used to diagnose plica syndrome. To perform the test, the patient lies supine with their lower leg off a table. They are instructed to move their leg into flexion, stopping at 30-60 degrees.
Treatment
Medial plica syndrome is one of the most common sources of anterior knee pain. It usually occurs in younger people. The cause of the condition can be overuse, injury, or inflammation. If the condition is not treated, it can lead to chondromalacia and cartilage damage.
There are many treatment options for medial plica syndrome. Some of these treatments include arthroscopy, non-operative physiotherapy, and steroid injections. However, the results of these treatments vary.
Non-operative physiotherapy is effective in improving the motion of the knee. Physical therapy also helps to avoid scarring. Symptoms will usually settle down in a few weeks.
Surgery may be necessary if the above options are not enough to reduce the symptoms. Surgical resection is a surgical procedure that involves removing the plica. During surgery, a surgeon will inspect the joint and other structures in the knee. This is done by inserting a fibre-optic camera into the joint.
In most cases, medial plica syndrome can be successfully treated by physiotherapy or arthroscopy. Depending on the type of plica, the recovery time will vary. Generally, a recovery of about six weeks is expected after arthroscopy.
MRI and X-rays can be used to diagnose the condition. An MRI will show whether the plica is inflamed or not. While X-rays will not show the plica, they can be helpful to rule out other conditions.
After a diagnosis of plica syndrome is made, the next step is to find a treatment that will work for you. Various exercises can be performed at home, including gentle stretches for your hamstrings, quadriceps, and calf muscles. You can also use ice packs to decrease swelling.
MRI scans are unreliable in determining if someone has a plica
A plica is a prominent synovial fold of the joint capsule. These folds vary in size, location and shape. They are often seen on an arthroscopic examination of the knee. In general, they are left alone unless they are found to be the source of a patient’s pain.
One study showed that the MRI was not as accurate as one might think. For example, a single case was mistaken for a medial meniscal tear and two cases of a fictitious “synovial plica syndrome” were muddled in the clinical evaluation. As a result, only thirteen people had their treatment plans altered based on the MRI.
Similarly, magnetic resonance imaging did not prove to be the best preoperative diagnostic tool for the plicae of the knee. Rather, the arthroscopic procedure was a better predictor of the presence of a plica. Although the plica is not a source of pain, it does present an interesting anatomical challenge, and it can be removed by arthroscopy.
Using a small camera, the plica is gently tugged away. This is not always a straightforward task, and it is only done if a plica is suspected. If a plica is left in place, its thickness may cause chronic pain.
A recent study investigated the reliability of MRI in identifying a plica in an asymptomatic patient. The results were surprising. Of the 23 patients studied, 16 had results that were interpreted correctly by a general practitioner. However, only 13 had changes in their treatment plans.
Despite these limitations, MRI was not an ineffective preoperative diagnostic tool. It is best not to make a rash decision without proper testing. When deciding on a course of action, the most important thing is to determine whether the plica is a cause of pain and whether it is worth taking a surgical approach.
Arthroscopic surgery
Medial plica syndrome is a medical condition that causes pain in the front of the knee. It can be diagnosed and treated by arthroscopic surgery. Surgical treatment is appropriate when non-surgical treatments do not provide relief.
There are two primary plica types. The most common is the C fold. A second plica type is the B fold. In general, a healthy medial plica has smooth elastic properties.
Pathological plicas can develop when inflammation or fibrosis occurs. An arthroscopic resection can remove the plica. Corticosteroid injections can help decrease inflammation. Several studies have found that patients with pathological plicas respond well to arthroscopic resection.
Arthroscopic surgery for medial plica syndrome usually requires only a small incision. Through this incision, a small camera is inserted. One or two additional small incisions are made to allow for the insertion of surgical instruments into the knee.
Patients who are diagnosed with Medial Plica Syndrome may experience anterior knee pain and irritation of the patella. This can lead to further cartilage deterioration. If the plica is causing discomfort, an exercise program may be beneficial. Gentle exercises can help reduce swelling and improve the range of motion.
Recovery from arthroscopy is usually quick. Normally, a patient can return to normal activities within a few weeks. However, some people may require a longer recovery time. Depending on the severity of the condition, a patient may need to limit certain activities.
Performing a thorough physical exam should determine whether a plica is causing the problem. An MRI can confirm the diagnosis. But it is not always accurate. Symptoms of plica syndrome are indistinguishable from other knee pathologies. Therefore, it is important to discuss all of your medical history and medications with your healthcare provider.
Knee Plica Syndrome: Symptoms, Causes, Treatment (webmd.com)
Plica Syndrome – Physiopedia (physio-pedia.com)