Medial plica irritation: diagnosis and treatment

Additional article information

Abstract

Medial plica irritation of the knee is a very common source of anterior knee pain. Patients can complain of pain over the anteromedial aspect of their knees and describe episodes of crepitation, catching, and pseudo-locking events with activities. Patients commonly have pain on physical examination upon rolling the plica fold of tissue over the anteromedial aspect of their knees and often have tight hamstrings. The majority of the patients will respond well to a non-operative treatment program consisting of quadriceps strengthening along with concurrent hamstring stretching. In cases which do not respond initially to an exercise program, an intraarticular steroid injection may be indicated. In those few patients who do not respond to a non-operative treatment program, an arthroscopic resection of their medial plica may be indicated, especially in those cases where a shelf-like plica has been found to be causing damage to the articular cartilage of the medial femoral condyle.

Keywords: Plica irritation

Anatomy

The medial plica of the knee is a thin, well-vascularized intraarticular fold of the joint lining, or synovial tissue, over the medial aspect of the knee (Fig. 1). It is present in everyone, but is more prominent in some people. It has been noted to be present as a shelf of tissue over the medial aspect of the knee at the time of arthroscopic surgery in up to 95% of patients . Proximally, it is attached to the genu articularis muscle, while distally it courses over the far medial aspect of the medial femoral condyle to attach to the distomedial aspect of the intraarticular synovial lining of the knee. At this location, it basically blends into the medial patellotibial ligament on the medial aspect of the retropatellar fat pad . The medial plica is composed of relatively