pathology: plica syndrome

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plica syndrome

Definition of

The plicae synoviales are folds of synovia that have not regressed after embryonic formation of the knee. The knee joint develops fetally from three compartments separated by synovial septa: one lateral, one medial and one patellar. In 25-30% of cases, these septa only regress incompletely and the synovial plicae remain:
Plica synovialis mediopatellaris (MPP)
Plica synovialis infrapatellaris (IPP), sometimes referred to as lig. mucosum
Lateral synovial plica
Plica synovialis suprapatellaris (SPP)
which then remain asymptomatic in 50-70% of cases.
Due to their elastin and fatty tissue content, they do not normally pose a problem. They usually remain asymptomatic and are detected at most as an incidental finding. The plica synovialis mediopatellaris(medial shelf) is the one that most frequently leads to disorders because it is located in an easily irritated area.

Even minor trauma to the over-cartilaginous femoral condyle when the knee joint is significantly flexed or frequent flexion and extension of the knee joint can lead to inflammation and thickening of the plica, which can irritate and damage the underlying articular cartilage of the femoral condyle. Complaints caused by a plica can resemble those of meniscus damage or retropatellar cartilage damage: Inhibition of flexion or extension, snapping of the knee joint, even after standing up from sitting. The symptoms occur more frequently after weight-bearing and are mainly medial or retropatellar. The plica synovialis mediopatellaris can be palpated as a rough, possibly painful cord cranial to the joint space. Snapping between the patella and femoral condyle when flexing and extending the knee joint can be an indication, as can snapping at the same point when the knee joint is flexed against slight resistance from active extension. As the plica can fibrosize, it tends to damage the cartilage in contact.

In principle, friction between the plica and cartilage is asymptomatic apart from snapping phenomena as long as the cartilage is intact; if the cartilage wears out and the plica rubs against bone, pain occurs, usually only during/shortly after heavy strain, as the plica mechanically irritates and abrades the cartilage, this results in osteoarthritis.

Incarcerations of the plica immediately cause severe discomfort with light strain. The plica that has not regressed can be prone to irritation or entrapment in the event of overuse, trauma or distortion trauma (strain).

ICD M67.8

Cause

  1. Overuse during cyclical movements with squats and stretches such as running, cycling and stepping
  2. traumatic: impact trauma such as impact or fall

Predisposing

  1. repeated cyclical movements with load on the knee joints

Diagnosis

  1. sometimes palpable plica
  2. MRI
  3. Tests: Hughston-Plica test, stutter test, as with retropatellar cartilage damage(osteoarthritis or chondropathy patellae), the Zohlen sign can also be positive here.

Symptoms

  1. Mostly mediopatellar or retropatellar pain during knee extension and flexion, such as climbing stairs
  2. later also pain at rest, only with existing cartilage damage
  3. Pain may radiate into the back of the knee
  4. Restriction of movement
  5. Creaking or cracking, with or without pain
  6. Feeling of locking when stretching
  7. Stiffness after sitting for a long time
  8. Gentle posture
  9. Snapping of the plica or pinching
  10. Swelling if necessary
  11. Possibly mediodorsal snapping sensation during movement or after prolonged sitting
  12. Intermittent incarcerations if necessary

Complications

  1. Postural damage due to poor posture
  2. Osteoarthritis: cartilage damage due to friction

Therapy

  1. KG: stretching, strengthening, mobilization of the plica
  2. Possibly rest, rest, sports break
  3. Cooling
  4. Anti-inflammatory drugs for 2-3 weeks
  5. If there is sufficient space in the joint and the cartilage is still intact conservative: reduction of strain, anti-inflammatory drugs, analgesics, typically: ibuprofen
  6. If conservative treatment is unsuccessful or frequent sport is expected to damage the cartilage by rubbing the plica: early arthroscopic removal so that the cartilage is not damaged. In athletes, spontaneous healing without therapy is rare. After arthroscopic removal and removal of the drainage, full weight-bearing is possible quite quickly. Any remaining pain is then due to cartilage damage that has already occurred. In children, arthroscopy is only performed if conservative therapy fails.
  7. platelet-rich plasma (ACP), local cortisone infiltration