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James McCormack is a Physical Therapist who specialises in knee, foot & ankle injuries. www.james-mccormack.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.
Plica syndrome is very common, with the most mediopatella plica being the most commonly affected. A definitive prevalence of plica syndrome in the general population is unknown. The estimated prevalence sits around 20%, with studies reporting a range from, 10% to more than 80% (Al-Hadithy et al, 2011). This is difficult to establish, as the only absolute diagnosis is with arthroscopy. This invasive procedure is only done when necessary for treatment, so diagnosis is unconfirmed in many cases.
Plica syndrome is often caused by trauma to the knee, which can be from an injury. It is a common cause of knee pain for athletes who run or cycle, but can also be caused from an impact from a fall. It is frequently seen following a road traffic collision if the knee has been impacted against the dashboard. Injury does not have to be acute, it can also be triggered by chronic overload to the knee joint, individuals with high volumes of training and endurance athletes are particularly at risk.
Another form of trauma that can cause plica syndrome is surgery to the knee, with arthroscopes being a frequent cause of irritation. The irritation can cause inflammation and hypertrophy or thickening of the plica membrane. The listed risks from arthroscopy, total knee replacement and ACL reconstruction include plica syndrome.
Reducing swelling for plica syndrome is similar to any other injury to the knee. Elevation, compression and ice are all good treatments that have this effect and can therefore reduce pain. Elevation of the knee should be above the heart and for at least 20 minutes several times per day, and compression should be with a tight compressive sleeve or sock that goes over the knee. Ice should be applied as a pack for 10-20minutes or as an ice massage, ensuring there is no prolonged direct contact of the ice on the skin.
In most cases, it takes 4-6 weeks to recover from plica syndrome. If the correct diagnosis is made in a timely fashion and the appropriate treatment is started as soon as possible, most cases will recover with conservative treatment. Occasionally, this will not resolve the symptoms and additional treatment such as a steroid injection or surgery may be necessary.
Plica syndrome can reoccur if the plica membrane is irritated again. In chronic cases, the plica will become thickened and fibrotic which means it is less flexible and more likely to get caught. It is therefore more likely to reoccur as the plica is more likely to be impinged.
Surgery for plica syndrome involves removal of the whole or a part of the plica. It is uncommon for the plica to regrow and cause symptoms again. However, if only a small portion of the plica was removed and if the plica thickened and fibrosed as it scared from the surgery then it is possible to cause symptoms again.
While plica syndrome is symptomatic, it is not advisable to run, as this will likely worsen those symptoms. Swelling should have fully resolved and full, pain free range of movement of the knee returned before considering a return to impact and running. Before returning to running, it is good to test the knee with single leg hopping to check for pain on impact and to check for any delayed onset of symptoms such as pain or swelling. If it is pain free to hop and there are no symptoms in following the 24 hours, it may be sensible to start a phased return to running, such as with a run walk programme.
Applying elasticated tape such as KT tape or RockTape can reduce symptoms of plica syndrome for some people. Tape should be applied with stretch to the inside of the knee, or over the painful area. Watch this video to see the correct application technique.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.