Did you know that your knees contain plicas?
If this is news to you, you’re not alone! Few people have ever encountered the word “plica” – let alone realised they have several inside them.
Plicas (sometimes also known as plicae in the plural) are actually worth understanding, though, because they can sometimes cause problems in our knee joints. And because “plica syndrome” can be tricky to diagnose, patients sometimes end up being passed from doctor to doctor while the issue goes undetected.
So what exactly are plicas? And how do they cause problems in the knee?
What is a plica?
The word plica comes from the Latin verb plicare, meaning “to fold”. A plica is exactly that: a fold in the tissue lining the knee joint (the so-called synovial membrane). Opinions differ on whether plicas play a functional role in the knee. They may help the knee to bend and flex. Or they may simply be remnants from when the knee was developing in the womb, similar to the embryonic webbing between our fingers and toes.
So what is plica syndrome?
Plica syndrome is what happens when the fold of tissue thickens and starts to cause rubbing or irritation inside the joint. This usually affects the medial plica, which is on the inside of the knee to the side of your kneecap. But it can occur elsewhere, for example to the infrapatellar plica, just behind and below the kneecap. Several things can cause the plica to thicken like this, including a sudden impact injury, or overuse – for example, after taking up a new form of vigorous exercise.
What symptoms does plica syndrome cause?
A thickened plica won’t necessarily cause symptoms. When it does, however, the main one is a localised pain near the affected plica. The pain will often come on during exercise, say 10-15 minutes into a run, or when walking up and down stairs, squatting, or bending. Plica pain can also be accompanied by a catching or locking feeling in the knee. You may even hear a faint clicking sound.
How would you diagnose the condition?
Plica syndrome often goes undetected because it doesn’t show up on x-rays (although they can be useful for ruling out other issues in the knee), and often isn’t obvious from an MRI scan either. That’s why it’s important to see a specialist in clinic, where they can examine you physically and discuss your symptoms and history. Sometimes the best, or indeed only, way to get a diagnosis is with an arthroscopy – a keyhole operation where we can get a proper look at the affected area.
How would you treat plica syndrome?
If the pain is fairly new, conservative treatment is often the best way forward because plica problems can clear up by themselves. That means rest, potentially pausing or changing your exercise regime, taking some simple anti-inflammatory pain relief (such as ibuprofen, if you can take it), and using an ice pack if there’s swelling.
What if it doesn’t clear up naturally?
If conservative treatments don’t resolve the problem and the pain simply won’t go away then we usually recommend keyhole surgery to remove the plica. This involves trimming back the thickened tissue with a tiny shaving instrument. There are lots of nerves in the plica areas, so recovery will take some time; the knee could be sore for six weeks or so after your operation. Physiotherapy may be helpful afterwards, too: strengthening the surrounding muscles, for instance by stretching the quadriceps and hamstrings, can speed recovery – and provide protection for your plicas in the long term.
If you’re struggling with knee pain, or wondering if plica pain might be the issue, don’t hesitate to get in contact with us for help. You can drop the team a line using the website, or call us direct on 01962 826107. We’ll be glad to fix up an appointment with Mr Bailey and help you get to the bottom of the problem.