Medial Plica (Shelf Plica)

- Discussion:
     - most common form of plica;
     - located over the medial femoral condyle;
     - vulnerable to direct trauma when the knee is flexed;
     - repeated trauma or irritation may lead to inflammation and fibrosis of the plica;
     - fibrotic plica has decreased elasticity which causes it to impinge on either the patella or the femoral condyle;

- Clinical Manifestations: (Medial Plica)
    - diagnosis of symptomatic plica is made by exclusion; and presence of a plica by itself, does not connote pathology;
    - symptoms may mimic those of a torn meniscus (eg. snapping, clicking, & medial joint line tenderness;
    - anterior knee tenderness may be attributed to the anteiror extension of the plica to the fat pad;
    - when thickened, the medial plicae may be palpated just above the joint line;
          - palpation of the plica may be facilitated by having the patient flex & extend knee while the surgeon palpates the medial condyle next to patella;

- Treatment:
    - symptomatic plicae are managed with rest & NSAIDS;
    - excision, while rarely indicated, is very effective when necessary;

- Arthroscopic Treatment: (knee arthroscopy);
     - position for arthroscopic visualization:
           - knee is extended;
           - joint is repeatedly flexed to check for impingement of medio-patellar plica on the medial femoral condyle or patella;
     - normal findings:
           - it runs along medial capsular wall between infrapatellar fat pad and medial capsule, hence dividing wall into a superior and inferior portion;
     - pathologic plica:
           - look for thickened shelf that impinges on medial femoral condyle or patella during flexion;
           - also look for evidence of femoral condylar cartilage damage from the plica

Results of resection of medial patellar plica through a supero-lateral portal as a main arthroscopic procedure.

Knee injuries: the role of the suprapatellar plica and suprapatellar bursa in stimulating internal derangement.  

Symptomatic Synovial Plicae of the Knee.

The pathological medial plica: criteria for diagnosis and prognosis.  

Diagnosis and treatment of the plica syndrome of the knee.

The plica syndrome: a new perspective.   

Symptomatic synovial plicae of the knee.   

The pathological plica in the knee. Results after arthroscopic resection.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, August 31, 2012 10:19 am