The medial plica: a clinical perspective

It has been nearly a century that medical community is discussing the existence of plica as a cause of knee pain. Still consensus has not been achieved over the management of this condition. Plicae are normal synovial infolds of the joint capsule, considered to be vestigial in nature, but can become symptomatic. We often get patients specially young and active adults with anteromedial pain of knee joint in our clinic. Injury to knee joint frequently precedes the development of symptoms, but regular overuse and chronic synovitis can also lead to pathological medial plica. Various etiological factors convert the normal elastic nature of medial plica to thick Wbrous structure. This Wbrotic band causes mechanical irritation and is also responsible for focal secondary chondromalacia. Clinical evaluation, history, and thorough examination of knee joint are necessary to establish the diagnosis and exclude other related pathological conditions. Various provocative tests that reproduce patient’s symptoms and a system to diagnose medial plica syndrome based on history and clinical examination have been described in literature. Newer imaging techniques, which are less hazardous and noninvasive, like dynamic ultrasonography and magnetic resonance imaging, are emerging as useful tools in diagnosing medial plica syndrome. Arthroscopy is the gold standard modality in diagnosing as well as treating the condition. It oVers surgeons to inspect whole joint and assess personality of plica and resection in same session. Conservative therapy has a place in the management but arthroscopic complete excision of pathological medial plica provides excellent results.