SYNOVIAL PLICAE

Plicae are synovial folds present in knee joint. If a plica contributes to patient’s symptoms, it is called pathological. Usually , there are four plicae present in knee. Sometimes , they are well developed and thickened. Many a times, they are rudimentary.

Plicae
1) Infrapatellar plica (ligamentum mucosa)
Infrapatellar plica is commonly present plica in knee. It runs from infrapatellar pad of fat and to intercondylar notch. Infrapatellar plica never produces symptoms.
2) Supra patellar plica
3) Lateral patellar plica or shelf
4) Medial patellar plica
Medial patellar plica is usually symptomatic and hence termed pathological. The plica runs along medial side of joint and over medial femoral condyle to insert into fat pad.

Clinical features
The symptoms are preceded by direct blow. There is pain and snapping.
Signs
1) clicking sensation on flexion of knee
2) Effusion
3) Localised tender spot above joint line. Plica may be palpable over medial femoral condyle.
4) Popping sensation around 30-40 degrees of flexion (due to thickening and hyalinisation of plica)

Management
Initial management is conservative with NSAIDS , Isometric exercises, and extension cast. Steroid injection are effective to relieve symptoms in early stages. However , a thickened plica need to be excised either open or arthroscopic.