Medial patellar plica syndrome
Medial patellar plica syndrome is one of the conditions that can be associated with the presence of synovial plicae of the knee (in this instance a medial plica). It can be a common source of anterior knee pain.
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Epidemiology
While it can affect those of any age, it typically involves the young patients involved in repetitive athletic activity.
Clinical presentation
Patients may present with pain over the anteromedial aspect of the knees (mostly above the joint line 8) and this may be accompanied by episodes of crepitation, catching, and pseudo-locking sensations.
Pathology
Knee plicae are synovial invaginations which are thought to be remnants of embryological development. Plicae ≥1 mm may be present in over 70% of individuals and are mostly asymptomatic 8,9. Under certain circumstances, they carry the potential to become inflamed and symptomatic. There can be fibrosis of a plica rendering it inflexible 8.
Radiographic features
Plain radiograph
Plicae are occult on plain radiograph.
MRI
Useful for identifying the presence of a plica and if it is thickened (typically appears like a shelf-like band). Signal characteristics of plicae are:
- T1: low signal
- T2/PD: low signal
In symptomatic patients, thickening of the medial plica and associated chondral defect of the medial patellar facet can be seen.
Treatment and prognosis
Management options range from the conservative end of rest - physiotherapy to corticosteroid injections to arthroscopic surgery.
Related Radiopaedia articles
Knee pathology
The knee is a complex synovial joint that can be affected by a range of pathologies:
- bone and cartilage
-
knee fractures
- distal femoral condyle fracture
- tibial plateau fracture (classification)
- patella fracture
-
avulsion fractures of the knee
- arcuate complex avulsion fracture (arcuate sign)
- anterior cruciate ligament avulsion fracture
- biceps femoris avulsion fracture
- iliotibial band avulsion fracture
- patella fracture
- posterior cruciate ligament avulsion fracture
- reverse Segond fracture
- Segond fracture
- semimembranosus tendon avulsion fracture
- Stieda fracturechronic avulsion injuries
- dislocation
- chondromalacia patellae
- osteoarthritis of the knee
- osteochondral defects
- osteochondritis dissecans of the knee
- patterns of bone bruise in knee injury
-
knee fractures
- ligaments
- anterior cruciate ligament tear
- anterior cruciate ligament ganglion cyst
- anterior cruciate ligament mucoid degeneration
- posterior cruciate ligament tear
- medial collateral ligament tear
- lateral collateral ligament tear
- medial patellofemoral ligament tear
- posterolateral corner injury
- posteromedial corner injury
- tendons
- meniscal lesions
- bursosynovial lesions
- fat pad
- popliteal fossa
- fascia
- alignment
- knee
- patellofemoral
- gamut