Medial Synovial Plica Irritation
Treatment
The literature suggests an emphasis on quadriceps strengthening (quadriceps sets, SLR, leg presses, mini-squats, walking program, recumbent /stationary bike, swimming) and stretching the hamstrings because the medial synovial plica is attached to the genu artciularis and indirectly to the quadriceps at the joint lining. Poor muscular tone and balance around the knee can cause dysfunction. It is recommended to avoid knee extension exercises in open chain position because it may increase irritation.
If non-operative management is unsuccessful, the patient may opt for an arthroscopic resection (rarely needed). However, the procedure will lead to scarring and tissue may heal with a painful scar, leading to more symptoms. It is only beneficial in the condition when the plica presents as a shelf, catching over the medial femoral condyle and causing erosion of the articular cartilage. This procedure is more successful in adolescents than older population.
Intraarticular corticosteroid injection may be considered as a temporary option to address symptoms, but it is vital to look at the underlying cause. After injection, the patient may require 24-48 hours of rest and refraining from exercise/stress due to post-injection soreness.
Treatment Summary:
If non-operative management is unsuccessful, the patient may opt for an arthroscopic resection (rarely needed). However, the procedure will lead to scarring and tissue may heal with a painful scar, leading to more symptoms. It is only beneficial in the condition when the plica presents as a shelf, catching over the medial femoral condyle and causing erosion of the articular cartilage. This procedure is more successful in adolescents than older population.
Intraarticular corticosteroid injection may be considered as a temporary option to address symptoms, but it is vital to look at the underlying cause. After injection, the patient may require 24-48 hours of rest and refraining from exercise/stress due to post-injection soreness.
Treatment Summary:
- Decrease pain
- Minimize swelling
- Examine gait parameters
- Consider orthopedic consult
- Increase/maintain pain-free full ROM
- Increase.maintain quadricep strength
- Stretch hamstrings
Prevention
Protect the joint during potentially aggravating activities and train appropriately for specific physical activities
Education
- Limit physical activities involving repetitive knee flexion and extension that may aggravate symptoms
- Avoid sustained knee flexion postures
- Proper training for a specific physical activity (avoid weekend warriors)
- Be aware of recent changes in running surface, footwear, or orthotics
- Maintain and increase the integrity of the knee musculature and joint
References
Griffith CJ, LaPrade RF. Medial plica irritation: diagnosis and treatment. Curr Rev Musculoskelet Med. 2008;1(1):53-60.
Dressendorfer R, Granado MJ. Plica syndrome. CINAHL Rehab Guide. Dec 9, 2011.
Dressendorfer R, Granado MJ. Plica syndrome. CINAHL Rehab Guide. Dec 9, 2011.