Plica syndrome is an interesting problem that occurs when an otherwise normal structure in the knee becomes a source of knee pain due to injury or overuse. The diagnosis can sometimes be difficult, but if this is the source of your knee pain, it can be easily treated.

Hear from some of our patients who we treated for Knee Pain

“ Agnes Schrider was terrific and I actually went paddle boarding at Lake Monacan at the end of August for the first time ever and successfully paddled around the lake three times. Pretty good for age 76 and two artificial knees plus pins and a plate in my left ankle. My 18-year-old granddaughter wants to come with me next summer and I can't wait. I constantly sing your praises..... and that of Agnes.... ”

Dianne

“ Amy and Amanda are caring and supportive! My recovery from a partial knee replacement is going very well since I started working with these two ladies. The support has helped me find my confidence to put one foot in front of the other to reach my goals. This is the only place I will ever go when for physical therapy. I have been a loyal client for about 8 years. ”

Charlotte T

“ I recently finished physical therapy at PT@acac in Crozet after my knee replacement. I actually enjoyed the therapy! The therapists were all pleasant and fun to work with. I'll go back there if I need more therapy, and I recommend them to others - especially seniors who may need therapy. ”

Gertrude H

Crozet, VA

“ I am 79 years old and in good health. I recently had Total Knee Replacement surgery on my right knee. After a brief series of Physical Therapy (PT) sessions in-home, I started the surgeon’s prescribed PT with a local practice. Having no prior experience with PT, this was a total random choice and it was there that I met Sam. I was immediately impressed with his personal interest in my needs and how knowledgeable he was of this surgery. He designed a regimen of stretches and exercises to help me regain the flexibility lost in surgery. After 4 weeks of PT 3 days per week, I have about 90% of the flexibility back and he has reduced the sessions to 2 days per week. During each of my visits, I watched him work with other patients with different needs just as efficiently. I also saw how the other PT’s in the practice continually sought his advice and help. If you are in need of PT, I would highly recommend Sam. He is a Pro with the expertise to help you. George Dasher, Culpeper, VA ”

George D

“ Complete confidence in Nick's instruction and is very attentive throughout the session. ”

Martha B

Charlottesville, VA

“ I wanted to share a positive experience with you in hope that Sam receives the recognition that he very much deserves. My ten year old daughter has been working with Sam for a few months for physical therapy in the Waynesboro location. We have been very impressed with Sam and are so thankful for his care and attention toward my daughter. Every week he seems to have a new activity for her that is age appropriate and keeps her engaged. He is creative and knowledgeable and always seeks feedback from us and provides updates on her progress. As someone who works in a therapy setting, it is so refreshing to see his approach toward her and her individual therapy needs and we are so grateful for this. ”

Ashley L

Anatomy

Plica is a term used to describe a fold in the lining of the knee joint. Imagine the inner lining of the knee joint as nothing more than a sleeve of tissue. This sleeve of tissue is made up of synovial tissue, a thin, slippery material that lines all joints. Just as a tailor leaves extra folds of material at the back of sleeves on a shirt to allow for unrestricted motion of the arms, the synovial sleeve of tissue has folds of material that allow movement of the bones of the joint without restriction.

Four plica synovial folds are found in the knee, but only one seems to cause trouble. This structure is called the medial plica. The medial plica attaches to the lower end of the patella (kneecap) and runs sideways to attach to the lower end of the thighbone at the side of the knee joint closest to the other knee. Most of us (50 to 70 percent) have a medial plica, and it doesn't cause any problems.

Causes

A plica causes problems when it is irritated. This can occur over a long period of time, such as when the plica is irritated by certain exercises, repetitive motions, or kneeling.

Activities that repeatedly bend and straighten the knee, such as running, biking, or use of a stair-climbing machine, can irritate the medial plica and cause plica syndrome.

Injury to the plica can also happen suddenly, such as when the knee is struck in the area around the medial plica.

This can occur from a fall or even from hitting the knee on the dashboard during an automobile accident.

This injury to the knee can cause the plica, and the synovial tissue around the plica, to swell and become painful.

The initial injury may lead to scarring and thickening of the plica tissue later.

Symptoms

The primary symptom caused by plica syndrome is pain. There may also be a snapping sensation along the inside of the knee as the knee is bent. This is due to the rubbing of the thickened plica over the round edge of the thighbone where it enters the joint. This usually causes the plica to be tender to the touch. In thin people, the tissue that forms the plica may be actually be felt as a tender band underneath the skin. In rare cases where the plica has become severely irritated, the knee may become swollen.

Snapping Sensation

Diagnosis

When you visit PT@acac, we will begin your diagnosis with a history and physical exam. The examination is used to try and determine where the pain is located and whether or not the band of tissue can be felt.

Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the Physical Therapists at PT@acac have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.

Our Treatment

The majority of people with plica syndrome will get better without surgery. The primary goal when treating the plica is to reduce the inflammation. This may require limiting activities like running, biking, or using a stair-climbing machine.

When you begin Physical Therapy at PT@acac, we may first suggest anti-inflammatory medications such as ibuprofen or aspirin to reduce the inflammation. Our Physical Therapist may also use ice packs or ice massage to help reduce the inflammation and swelling in the area of the plica. Ice massage is easy and effective. Simply freeze water in a paper cup. When needed, tear off the top inch, exposing the ice. Rub three to five minutes around the sore area until it feels numb.

Additionally, we may apply treatments such as ultrasound and friction massage to calm inflammation in the plica. Our therapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine to the sore area. This treatment is especially helpful for patients who can't tolerate injections.

Once the inflammation is reduced, our Physical Therapist will begin treatments involving stretching and strengthening exercises for the leg.

Although the time required for recovery varies, if your treatment is nonsurgical, you should be able to return to normal activity within four to six weeks.

When you begin post-surgical Physical Therapy, our first few rehabilitation sessions will be designed to ease pain and swelling and help you begin gentle knee motion and thigh tightening exercises. Patients rarely need to use crutches after this kind of surgery.

As our program evolves, our therapist will choose more challenging exercises. Patients do closed chain exercises by keeping their foot on a surface while working the knee joint. These exercises mimic familiar activities like squatting down, lunging forward, and going up or down steps. These exercises help keep pressure off the kneecap while getting a challenging workout for the leg muscles. Our Physical Therapist will work with you to make sure you are not having extra pain in your knee during the exercises. We may also have you do stretches for the soft tissues along the edge of the kneecap as well as flexibility exercises for the hamstrings, quadriceps, and calf muscles.

At PT@acac, our goal is to help you keep your pain under control, increase the strength of your quadriceps muscles, and maximize the range of motion in your knee. When your recovery is well under way, regular visits to our office will end. Although we will continue to be a resource, you will be in charge of doing your exercises as part of an ongoing home program.

Surgery

If all nonsurgical attempts to reduce your symptoms fail, surgery may be suggested. Usually, an arthroscope (mentioned earlier) is used to remove the plica. The small TV camera is inserted into the knee joint through one-quarter inch incisions. Once the plica is located with the arthroscope, small instruments are inserted through another one-quarter inch incision to cut away the plica tissue and remove the structure. The area where the plica is removed heals back with scar tissue. There are no known problems associated with not having a plica, so you won't miss it.

Plica Syndrome

Introduction