Monday, October 31, 2011

Medial Plica Syndrome Unlikely Caused By Auto Accident ~by Dr. B.


I was recently asked if a young woman's medial plica syndrome was caused by an automobile accident. While the answer is "probably not," the explanation is perhaps more useful than the answer. The medial plica of the knee is a thin, well-vascularized intraarticular fold of the joint lining, or synovial tissue, over the medial (inner) aspect of the knee. Medial plica irritation of the knee is a common source of anterior knee pain; however, it is rarely associated with a single event of trauma. The inflammation in the vast majority of cases occurs because of chronic irritation to the medial plica either due to excessive exercise or chronic trauma.

Furthermore, while patients may complain of discomfort over the anteromedial portion of the knee with periodic popping or pseudo-locking, the individual usually maintains a high level of function in the joint. Such patients exhibit discomfort upon rolling the plica fold of the tissue over the anteromedial (front inside) portion of their knee. While patients often wish to blame the discomfort on a single bruising to the knee, the typical patient exhibits tight hamstrings and weak quadriceps. This chronic imbalance is the likely culprit of the continued irritation and inflammation. It is well known that chronic plica problems can develop when the medial plica is irritated by certain exercises that involve repeatedly bending and straightening the knee, such as aerobics, biking, using a stair machine, or jogging. As a result, the development of medial plica syndrome is more likely the result of chronic irritation caused by the muscle imbalance as opposed to a single bruising of the knee. In patients with multiple injuries, multiple surgeries or chronic irritation over the medial aspect of the knee, the medial synovial plica may become very thick and fibrotic causing it to catch over the medial aspect of the medial femoral condyle (thigh bone.) [ Links: *, **]. The catching over the medial aspect of the medial condyle typically explains the report of popping or crepitation.

All most all patients improve with physical therapy and/or a steroid injection. Arthroscopic surgery is extremely rare and should not be performed until all nonsurgical alternatives to treatment have been exhausted. Nonsurgical measures can remedy most cases of plica syndrome by reducing inflammation. Anti-inflammatory medications such as ibuprofen or aspirin typically help. Ice massage may also be beneficial. To restore muscle balance, a treating physician should insist on exercises to strengthen the thigh muscle (quadriceps) and stretch the hamstrings. Moreover, an arthroscopic resection of the medial plica should only be performed in the rare case that the plica is actually damaging the articular cartilage of the medial femoral condyle. This is not the typical case and therefore the option of surgery is rarely appropriate in the absence of concrete indications. For additional details read "Medial Plica Irritation: Diagnosis and Treatment by Chad J. Griffith and Robert F. LaPrade of the Department of Orthopedic Surgery University of Minnesota. LINK ***. Chad Griffith opines that 95 percent of people have a medial plica but only a small percentage of people will experience pain from their plica. Few will require surgery because almost everyone responds to a therapy program emphasizing hamstring stretching and quadriceps strengthening. Also consider:





26 comments:

Brenda said...

I iced my knee for two weeks. I went back to jogging and it came back. I then did physical therapy 12 visits and completely recovered. I understand that the imballance causes the ligaments and the bones to not track right which causes irritation. I am glad I listened to the physcial therapist.

Anonymous said...

Great explanation. I think all of those suffering with medial knee pain need to read this article.

Anonymous said...

I developed medial plica pain after 3 years of horseback riding. I stopped riding and it went away.

Anonymous said...

They thought I had medial plica syndrome but it turned out I had arthritis. I take ibuprophen and do pretty well.

Anonymous said...

I have achy knees from a tick bite. I initially tested negative for Lymes but still ended up having some time of a bite related inflamation.

Anonymous said...

I think what this article means is that most of the medial knee pain is from overuse. Its what we used to call tendinitis in the knee.

Thanks for sharing Dr. B.

Anonymous said...

Thanks for the medical articles links.

Anonymous said...

I wasn't in no accident and I developed medial knee pain. The doc told me that sometimes just getting up from a chair can cause inflamation and even tears in the menisci.

guess it is just part of the aging process... although I am only 29.

Anonymous said...

I marched in the band in high school. By the time I was a senior, I had inner knee pain. The doctor said I had tendonitis. Guess that is the same thing as this medial plica stuff.

California Surfer Dude said...

The return of Good Old Doc B. Always appreciate your guest posts. I wish I could read more of them... of course I also wish I were rich, handsome and healthy so I wouldn't have to read anything.

Surfer Dude

Anonymous said...

My knee started hurting when I got up out of a chair. I heard a pop and it started to swell. Dr thought I had a torn meniscus but it was fine when he went in with the arthroscope. He said my medial plica was thick and fibrous so he shaved it.

My knee still hurt so I had 6 weeks of physical therapy and it finally got better.


It was a long journey which all started just standing up out of a chair.

Anonymous said...

my advice is suck it up and learn to live with a little bit of pain. Life is tough. Wear a helmut and get on with living.

Happy Camper said...

I had torn cartiledge. I got arthoscopic surgery and am cured!

Legal Pub said...

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Ortho Man said...

Followed you over from Twitter. Synovial plicae are normal anatomic structures of the knee that sometimes become symptomatic. Magnetic resonance imaging and MR arthrography help visualize synovial plicae and allow differentiation of these entities from other causes of knee pain. On MRI, synovial plicae appear as bands of low signal intensity within the high-signal-intensity joint fluid. Gradient-echo T2-weighted and fat-suppressed T2-weighted or proton density–weighted MR images should allow us to evaluate the plicae.

Plica syndrome is when pain impairs the knee function. It is demonstrated by visual presence of a thickened and fibrotic plica. It should be differentiated from other types of derangement of the knee. A diffusely thickened synovial plica can be associated with synovitis or erosion of the articular cartilage of the patella or femoral condyle. In the absence of other significant MRI findings, Orthopedic Surgeons often come to the diagnosis of plica syndrome.

Once confident in the diagnosis, nonsurgical treatment is preferable. Only after failure to improve with conservative treatment shoud arthroscopic excision of the plica be performed in my opinion.

Anonymous said...

In all my years of sports medicine, I do not recall ever an athlete recieving surgery on a Plica Band and certainly nothing on the medial side. In fact even with grade III tears of the medial collateral ligament, we do not attempt surgical repair because time is the best healer.

Anonymous said...

In my experience medial plical band syndrome is most commonly caused by repetitive knee flexion-extension such as found with
1.Rowing
2.Swimming
3.Cycling
4.Aerobics/ Zoomba
5.Squating
6.Gardening
7.Walking up and down stairs

Symptoms tend to be:
A.Medial patella discomfort
B.Snapping sensation with knee flexion
C.Repeated flexion and extension motion

Treatment; Stretch your hamstrings and build up your quads.

Anonymous said...

If a plica is swollen or enlarged, an MRI might identify it as the source of pain. However, the MRI can be misleading. Even if one has an enlarged plica, it might not be the source of the pain.

Treatment of a painful plica is almost always nonoperative.

Anonymous said...

Thanks for all the medical advice. I realize that if you don't have a torn ligament or a locked knee from a torn meniscus, you are better off being conservative. No way would I get a surgery that isn't needed.

Anonymous said...

There are more than 50 types of arthritis. However, a swollen, achy joint does not mean you have one of them. "You need to be properly diagnosed and treated," says Elaine Husni, M.D., M.P.H., director of the Arthritis and Musculoskeletal Center Orthopedic and Rheumatologic Institute, at the Cleveland Clinic.

Knee pain can be the result of arthritis, soft tissue irritation or bursitis. Always get a second or third opinion before surgery.

Anonymous said...

Sounds like wise advice

Anonymous said...

Morning joint pain is often related to osteoarthritis. The pain usually doesn’t last long. “ ... morning stiffness with osteoarthritis is less than 5 to 10 minutes as a rule,” says Nathan Wei, MD, clinical director of the Arthritis and Osteoporosis Center of Maryland.

The sooner you get up and move the joint, the more quickly the joint loosens up.

Anonymous said...

Makes sense. Move it or lose it.

nika said...

i just had an arthroscopy because of this. i have suffered from the pain for almost 1 year. i tried to rest it out but the symptoms remained. i'm an athlete and i took the risk of the surgery because i couldn't just go back playing because of the pain. my doctor thought of torn ligament or meniscal tears, but the finding was medial plica in my left knee. i just hope and pray that i'll be able to recover as soon as possible.

Anonymous said...

Nina: good luck. Recovery without surgery just takes time. With surgery the recovery should be shorter.

Anonymous said...

Hope you exhausted consevative treatment options before you chose surgery, nika