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:

Plica: Pathologic or Not? [J Am Acad Orthop Surg. 1993]

Medial plica and degeneration of the medial femoral condyle. [Arthroscopy. 2006]