Medial Plica Syndrome

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Medial Plica Syndrome is an interesting problem that occurs when an otherwise normal structure in the knee becomes a source of knee pain due to injury or overuse. The diagnosis can sometimes be difficult, but if this is the source of your knee pain, it can be easily treated.

The symptoms of medial plica syndrome are very similar to those of other knee injuries. Consequently, plica syndrome is difficult to diagnose. Diagnosis usually depends on the exclusion of other conditions that cause similar symptoms, including:

  • Pain and swelling in the knee
  • A “clicking” sensation
  • A locking or weakness of the knee
  • Stiffness or tight sensation
  • Tenderness on the inner side of the knee

  • Causes:
    Plica problems can occur suddenly or over a long period of time. 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.

    The first concern is to decrease the inflammation of the synovial capsule. This can be attacked with numerous methods. First, the orthopaedic surgeon may prescribe a non-steroidal anti-inflammatory medication. Examples of these medications are Motrin®, DayPro®, Naprosyn®, Celebrex®, and Indocin®. These medications act systemmically to slow the inflammation process. Theraputic exericses and modalities may also be used to treat the plica. To attack the inflammation, modalities such as utilizing low intensity electric current to transport medications through skin, using ultrasound to transport medications through skin, and ice are most commonly utilized.

    Rehabilitative exercises should be instituted when the inflammation has been controlled and pain levels are falling. These exercises should focus on increasing overall quadriceps, hamstring, and calf strength., as well as increasing overall muscular flexibility. Examples of appropriate exercises are: pain-free squats that progress to one-leg squats, side step-ups, closed chain terminal knee extension, and applicable sport-specific exercises. Care should be taken to avoid deep squats as this can increase pain and inflammation.

    The exercises should be performed utilizing progressive resistance exercises principles, gradually increasing load and intensity as pain and inflammation allows.

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