Dr. Lox on Knee Plica Syndrome

Knee Plica: A Mystery of Sorts

Depending upon what sources you read, you may come away with different views on Knee Plica Syndrome. There are many of these types of syndromes in medicine. That is why they are called syndromes, and not diseases or well-constructed diagnoses. A syndrome is a collection of symptoms. Well-known syndromes with a similar confusing view on meaning or understanding are Fibromyalgia, chronic fatigue syndrome, thoracic outlet syndrome, restless leg syndrome, and complex regional pain syndrome.  Depending on the source of what is read all the above syndromes can be confusing to those who are reading, and to patients alike.

What is in a Name?

A Syndrome is a collection of symptoms that when grouped together may explain a medical condition. Yet a syndrome does not have to mean a specific known pathophysiological mechanism of development. A fancy way of saying you don’t have to know what causes it. Example: a cause and effect with testing may confirm. New knee swelling after trauma with bent knee and twisting. MRI imaging confirms a knee meniscal tear. Example: Acute Knee swelling, pain, redness, and warmth. 1 week after knee steroid injection. Knee joint aspiration revealed white blood cells and bacteria. Diagnosis: knee infection. Syndromes can be vague. There is no other good explanation, and it fits into a category that may be labeled as the syndrome. There should not be another explanation. However, syndromes may be faulted by incorrectly named it a syndrome when something else may explain it. Example: chronic fatigue syndrome and fibromyalgia may both be incorrectly diagnosed when Lyme’s disease is present. Fibromyalgia may be due to many underlying causes. Fibromyalgia means fibrous and muscle tissues that hurt. Quite non-specific.

Knee Plica Syndrome

A knee plica is a synovial fold left over from embryonic development.  One orthopedic definition of knee plica syndrome is based upon an anatomical and arthroscopic diagnosis that the plica is inflamed. It is presumed the plica may be inflamed as a result of irritation from rubbing against the kneecap or inner thigh bone. This may be due to a sudden injury to the area or repetitive overuse from kneeling or bending. There are normally 3 synovial folds. These are normal bends or creases in the lining of the knee. This lining is called the synovium.  The inner plica is known as the medial plica, this is the plica implicated in plica syndrome. So pain in the inner aspect of the knee may fit into a knee plica syndrome diagnosis.

Knee Plica and Synovitis

The knee synovium lines the knee joint. There is a synovial lining to all joints. Synovitis is inflammation of the synovium. Synovitis may be caused by many inflammatory processes such as Rheumatoid arthritis or gout. It also occurs in degenerative arthritis. Many things may cause this. One treatment for medial knee plica syndrome is rest and a knee cortisone injection. However, rest and a knee cortisone injection may help calm down many knee problems and is by nature non-specific. If rest, cessation of repetitive knee activity, and a cortisone injection helps resolve the issue, that makes life easy.  If it doesn’t or keeps recurring, now the problem may begin with knee plica syndrome.

Knee Plica Syndrome and Surgery

When knee pain is attributed to a knee plica irritation that fails to respond to conservation treatment, knee arthroscopic surgery may be recommended.  Cutting out the knee plica synovial fold sometimes alleviates the pain, but what if knee surgery doesn’t work? Removing a portion of knee synovium creates a defect, in what was normal body tissue. It tends to heal with scar tissue. The same thing happens often with back surgery, a notoriously poor success rate surgery.  If the synovial fold or plica is just a symptom, not a cause, the original source of inflammation remains despite the knee plica surgery.  Now however there is scar tissue in the knee, which is irreversible.  Causation of plical synovial swelling based on the scientific knowledge that all underlying causes are accounted for makes great sense. Many doctors are reluctant to diagnose or surgically treat a knee plica, while others routinely do so.  This is the mystery of knee plica syndrome, and why confusion exists. Therefore, readers and patients must be knowledgeable in regards to the downfalls of falling into a syndrome trap, when there may be another possible preside explanation. CONTACT US: Tampa Bay, Florida 727-462-5582 Beverly Hills, California 310-975-7033 www.drlox.com