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The knee
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Andrew Price, Nick Bottomley, William Jackson
There is still controversy as to whether ‘plica syndrome’ constitutes a real and distinct clinical entity. Some clinicians believe it is a significant cause of anterior knee pain. However, it may closely resemble other conditions such as patellar overload or subluxation; indeed, the plica may become troublesome only when those other conditions are present. The diagnosis is often not made until arthroscopy is undertaken. The presence of a chondral lesion on the femoral condyle secondary to plica impingement confirms the diagnosis.
Functional effects of kinesiology taping for medial plica syndrome: a prospective randomized controlled trial
Published in Physiotherapy Theory and Practice, 2022
The synovial plica of the knee, which was defined by Iino (Geraghty and Spear, 2017), emerges in the twelfth week of embryogenic development and is permanently present in a range of anatomical variations in most people (Lee, Nixion, Chandratreya, and Murray, 2017). Four types of plica are defined according to their morphology: 1) infrapatellar; 2) mediopatellar; 3) suprapatellar; and 4) lateral (Geraghty and Spear, 2017; Lee, Nixion, Chandratreya, and Murray, 2017; Zmerly, Moscato, and Akkawi, 2019). The incidences of suprapatellar plica and mediopatellar plica are the most frequent, ranging between 11% to 87% and 18% to 60%, respectively (Nakayama et al., 2011; Zmerly, Moscato, and Akkawi, 2019). In a study consisting of 3889 cases requiring arthroscopic knee surgery, the incidence of medial plica was 79.9% (Nakayama et al., 2011). Plicae are mostly asymptomatic, though physiological plica, which is flexible, soft, and thin, may have a pathological appearance or tear after acute trauma or repetitive stress injuries (Erickson et al., 2016). The pathological plica loses its elasticity, becoming hypertrophic and fibrotic, and eventually causes medial plica syndrome (MPS) as a result of impingement between the anterior medial femoral condyle and the medial facet of the patella during knee movements (Erickson et al., 2016; Lee, Nixion, Chandratreya, and Murray, 2017; Liu et al., 2018; Zmerly, Akkawi, Citarella, and Ghoch, 2020). The prevalence of MPS ranges between 3 and 30%, and it is one of the commonly overlooked knee pain syndromes (Lee, Nixion, Chandratreya, and Murray, 2017; Prejbeanu, Poenaru, Balanescu, and Mioc, 2017). MPS is characterized by pain during repetitive flexion and extension of the knee, pain in the anteromedial region of the patella following prolonged knee flexion, tenderness, swelling, intermittent pain, aggravation during physical activity particularly while ascending and descending stairs, and knee stiffness or crepitation during movements (Paczesny et al., 2019; Prejbeanu, Poenaru, Balanescu, and Mioc, 2017). The most common physical examination used to diagnose MPS is the mediopatellar plica (MPP) test, described by Kim, Jeong, Cheon, and Ryu (2004). The MPP test is conducted while the patient is lying in a supine position with an extended knee. Manual force is applied to the inferomedial portion of the patellofemoral joint with the thumb, and while maintaining this force, the knee is flexed at 90°. The MPP test is positive if the patient experiences pain while the knee is in extension and the pain is eliminated or markedly diminished when the knee is positioned in 90° of flexion. Diagnostic radiographic methods include magnetic resonance imaging (MRI) and dynamic ultrasonographic evaluation (Liu et al., 2018; Stubbings and Smith, 2014). While the most accurate method for evaluating medial plica is arthroscopy, which is an invasive method, MPS caused by pathological plica can be sufficiently diagnosed using MRI and the MPP test, without the need for an arthroscopy (Stubbings and Smith, 2014).