A plica is connective tissue in your knee that develops before you are born, and then persists into adulthood. Often, plicae tend to go away during human development, however they can persist and then occasionally become a symptomatic. There are two areas where these tend to cause problems. There is a plica that lives just inside of the patella (medial to it) and another that lies deep in the knee that shrouds the anterior cruciate ligament. This one may slightly tether the fat and patella tendon. Either one of these can become inflamed. The medial plica can become tender, assisting in the diagnosis.
Determing the plica as the source of pain can be challenging. Often pain is present over this tissue band medially, or sometimes there is pain deep in the knee that is difficult to explain by the patient’s history or exam. Sometimes an MRI can be helpful to show a thickened plica.
As with most orthopedic treatments, nonoperative options are always tried first. Rest, ice, anti-inflammatory medications and physical therapy are often helpful in reducing symptoms. If these are not enough, a steroid injection may be more effective. The last resort is a surgery to release the band of tissue from the inside.
The surgery is done arthroscopically, using very small incisions, to look directly at the plica tissue and then remove or cut it away. This short 20 minute procedure is done as an outpatient. Rehabilitation after surgery first addresses pain and swelling, as well as regaining range of motion. Strengthening begins as the knee becomes less inflamed and includes a program to get the thigh and leg muscles strong, as well as core muscles. I like to use physical therapists, usually right away, after surgery to coach you through the recovery process and utilize their expertise in regaining strength and endurance.
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Please let me know if you have specific questions about this topic. I would be happy to see you in the office, or ask a question: Ask Dr. Hacker.
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