What Is Your Knee Plica?
A plica is a fold of synovial membrane most commonly in the anteromedial aspect of the knee. A knee plica is present in about 50% of the population and is the remnants of embryonic connective tissue that failed to resorb during your foetal development fully. Luckily, most plicae are asymptomatic.
While your knee potentially has four plicae, it is the medial plica that is most likely to be symptomatic (Dupont 1997). It runs parallel to your medial patella just below your medial retinaculum and inserts into your fat pad.
What is Plica Syndrome?
Plica syndrome is essentially an inflamed plica. Your plica can catch during:
- repetitive knee straightening and bending,
- blunt trauma or knee twisting,
- fat pad irritation,
- altered knee motion,
- internal knee derangements, e.g. meniscal tears. (Schindler 2004)
Consider plica syndrome if you experience persistent knee pain and weakness in the quadriceps muscles. Plica syndrome often does not always occur in isolation, but concurrently with other knee conditions such as meniscal injuries, patellar tendonitis and Osgood-Schlatter’s Disease.
What are the Symptoms of Plica Syndrome?
Plica syndrome can be suspected when you have:
- Anteromedial knee joint line pain; especially medial femoral condyle.
- Visible and palpably tender plica.
- Audible clicking or snap during knee motion – painful arc 30 to 60 degrees. (Dupont 1997).
- Positive Duvet test: pain eased by using a duvet between your knees to ease the pain in bed.
- Pain with activities: ascending and descending stairs, squatting, rising from a chair or sitting for extended periods. (Shetty et al. 2007).
- Quadriceps atrophy is common in chronic cases.
How is Plica Syndrome Diagnosed?
Your physiotherapist will be able to diagnose plica syndrome clinically. It is more vital that you have your knee thoroughly assessed by a physiotherapist or sports doctor to exclude other knee pathologies, in particular, meniscal injuries.
An x-ray may be useful to rule out other associated pathologies but will not identify a plica. MRIs can detect plica inflammation. However, MRI is more helpful in diagnosing other pathologies that may be related to the plica irritation. A comprehensive examination by your physiotherapist or sports physician is preferable.
Plica Syndrome Treatment
Studies show that about 60% of patients with plica syndrome will settle successfully with conservative physiotherapy treatment within 6 to 8 weeks. (Lu et al. 2010).
Your physiotherapy treatment will aim to:
- Reduce pain and inflammation.
- Improve patellofemoral (knee cap) alignment via taping, bracing and exercises.
- Normalise your muscle lengths.
- Strengthen your knee: esp quadriceps (esp VMO) starting with closed-chain exercises and eventually progressing to open-chain exercises
- Strengthen your hip and lower limb muscles.
- Address foot biomechanics issues.
- Improve your proprioception, agility and balance.
- Improve your lower limb function and quality of movement, e.g. walking, running, squatting, hopping and landing.
- Minimise your chance of re-aggravating your plica syndrome. (Gerbino et al. 2007).
We strongly suggest that you discuss your knee injury after a thorough examination by a knee clinician such as a sports physiotherapist, sports physician or knee surgeon.
Should your symptoms persist beyond 3 to 6 months, consider arthroscopic knee surgery for a plica syndrome. The most successful surgery involves lateral retinaculum release to allow the patella to track more medially and thereby alleviate plica irritation as it rolls over the medial femoral condyle. Success rates exceed 85%. (Gerbino et al. 2007).
How to Prevent Plica Syndrome?
Since plica syndrome usually occurs concomitantly with other knee conditions, it is essential to be proactive in managing your other knee injuries. This proactivity involves maintaining normal knee joint alignment, adequate strength and flexibility in the muscles around the knee joint plus the rest of the lower limb. It is ensuring that you wear appropriate footwear that supports your foot biomechanics. Also, weight-management can play a role in the pressure exerted on lower limb joints, and thus should be something considered as a long-term preventative measure.
Braces for Plica Irritation
Many patients will try a knee brace. A brace that improves patellofemoral joint alignment seems to be the most effective to ease the plica-related pain.
An effective patellofemoral brace can be useful as an alternative to kneecap taping.
Common Causes - Knee Pain
Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.
Knee Ligament Injuries
- Knee Ligament Injuries
- ACL Injury
- PCL Injury
- MCL Sprain
- LCL Sprain
- Posterolateral Corner Injury
- Superior Tibiofibular Joint Sprain
Knee Meniscus Injuries
- Chondromalacia Patella
- Fat Pad Syndrome
- Patella Dislocation
- Patellofemoral Pain Syndrome
- Osgood Schlatter’s Disease
- Sinding Larsen Johansson Syndrome
Knee Tendon Injuries
- Corked Thigh
- Thigh Muscle Strain
- Hamstring Strain
- ITB Syndrome
- Popliteus Syndrome
- Muscle Strain (Muscle Pain)
- DOMS – Delayed Onset Muscle Soreness
Children’s Knee Conditions
Other Knee-Related Conditions
- Runner’s Knee
- Plica Syndrome
- Stress Fracture
- Overuse Injuries
- Restless Legs Syndrome
- How Do I Know If my Knee Injury Is Serious?
- Is Surgery Needed For My Meniscal Injury?
- Is Surgery Needed For My ACL Injury?
- What Are The Symptoms Of A Torn Ligament In Your Knee?
- Why Does My Knee Hurt On The Inner Side?
- Is Walking Good For Knee Pain?
- What Can I Do To Relieve Knee Pain?
For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your knee physiotherapist.
Acute Injury Signs
Acute Injury Management.
Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.
For detailed information on specific injuries, check out the injury by body part section.
Don't Ignore these Injury Warning Signs
Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.
Immediate Injury Treatment: Step-by-Step Guidelines
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
- Elevate the injured part to reduce swelling.
- Consult your health practitioner for a proper diagnosis of any serious injury.
- Rehabilitate your injury under professional guidance.
- Seek a second opinion if you are not improving.
Elite Sports Injury Management
You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving, or other problems will develop.
Ice or Heat?
We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Would you please ask us if you are uncertain about what to do next?
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries. Think where your damage is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:
- An inappropriately treated previous injury (e.g. old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury. Would you please use our advice to guide you out of pain quicker? And for a lot longer.
If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.
Acute Sports Injury Clinic
How to Best Care for Your Sports Injury?
There is never an excellent time for an injury. But we do know that most sports injuries occur over the weekend! That's why at PhysioWorks, we have established an Acute Sports Injury Clinic at a selection of our clinics on a Monday and Tuesday.
The acute sports injury consultation fee is significantly lower than a routine assessment and treatment consultation. In most cases, your private health will cover the full cost of your full acute injury physio assessment fee.
Why Use an Acute Sports Injury Clinic?
Your Acute Sports Injury Assessment Consultation allows us to provide you with:
- A quick and accurate diagnosis. One of our Sports Physiotherapist's or an experienced sports injury-focused Physiotherapist will confidently guide your new injury management.
- Early acute sports injury care, professional advice and education. What to do this week?
- Fast referral for X-rays, ultrasound or MRI scans to confirm your diagnosis.
- Prompt referral to Sports Physicians, GPs or Surgeons with whom we work if required.
- Immediate supply of walking boots, braces and rental crutches if needed.
- Low-cost professional service.
For more friendly advice or guidance, please call your nearest clinic to discuss your specific needs.