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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.