Plica Syndrome

Plica syndrome is a painful knee condition. Plica syndrome happens when folds of tissue in the knee called plica get swollen and rub against the kneecap or thigh bone.

What are the causes?

This condition can be caused by:

• Bending or twisting the knee over and over again.
• A hit to the knee.

What increases the risk?

The following factors make you more likely to develop this condition:

• Having hip or thigh muscles that are weak or tight.
• Having hip or foot problems that change the normal position of the knee.
• Having had a previous knee injury.
• Playing contact sports.
• Participating in activities that involve making the same knee movements over and over, like running, cycling, or swimming.

What are the signs or symptoms?

The main symptom of this condition is a dull pain in the front or side of the knee. The pain comes and goes. It may get better with rest, and it may get worse with activities like standing, kneeling, walking, running, or climbing stairs. Other symptoms of this condition include:

• Pain when pressing on your knee.
• A clicking or snapping feeling when you bend your knee.
• Feeling that your knee is locking or catching.
• Feeling like your knee is giving way (instability).

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• Imaging tests, such as MRI or ultrasound.
• A procedure to look inside your knee joint (arthroscopy).

During the physical exam, your health care provider may move your knee in different directions and feel your knee to check for pain and tenderness.

How is this treated?

This condition may be treated by:

• Resting your knee until pain and swelling go down.
• Avoiding activities that make pain worse.
• Icing your knee.
• Wearing a supportive sleeve around your knee.
• Taking medicine to reduce pain and inflammation.
• Getting injections in your knee.
• Starting range-of-motion and strengthening exercises (physical therapy) to restore full movement and to strengthen your thigh muscles.

If these treatments do not help after 6 months, you may need to have surgery to remove the swollen parts of your plica.

Follow these instructions at home:

If You Have a Sleeve:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Remove the sleeve if your toes tingle, become numb, or turn cold and blue.
• Do not let your sleeve get wet if it is not waterproof.
• Keep the sleeve clean.

Managing pain, stiffness, and swelling

• If directed, apply ice to your knee.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Raise (elevate) your knee to the level of your heart or above that level while you are sitting or lying down.
• Take over-the-counter and prescription medicines only as told by your health care provider.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe for you to drive.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.

Contact a health care provider if:

• Your symptoms get worse.
• Your symptoms have not improved after 6 months.

Plica Syndrome Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your knee. These exercises also help to relieve pain and stiffness.

Exercise A: Quadriceps, prone

1. Lie on your abdomen on a firm surface, such as a bed or padded floor.
2. Bend your left / right knee and hold your ankle. If you cannot reach your ankle or pant leg, loop a belt around your foot and grab the belt instead.
3. Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise B: Hamstring, doorway

1. Lie on your back in front of a doorway with your left / right leg resting against the wall and your other leg flat on the floor in the doorway.
2. Straighten your left / right knee. You should feel a stretch behind your knee or thigh. If you do not feel that stretch, scoot your buttocks closer to the door.
3. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise C: Gastrocnemius, standing

1. Stand with your hands against a wall.
2. Extend your left / right leg behind you, and bend your front knee slightly. Keep both of your heels on the floor.
3. Keeping your heels on the floor and your back knee straight, shift your weight toward the wall. You should feel a gentle stretch in the back of your lower leg (calf).
4. Hold this position for __________ seconds.
5. Return to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your knee. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise D: Straight leg raises (quadriceps)

1. Lie on your back with your left / right leg extended and your other knee bent.
2. Tense the muscles in the front of your left / right thigh. When you do this, you should see your kneecap slide up or see increased dimpling just above the knee.
3. Keep these muscles tight as you raise your leg 4–6 inches (10–15 cm) off the floor.
4. Hold this position for __________ seconds.
5. Keep these muscles tense as you lower your leg.
6. Relax the muscles slowly and completely.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Straight leg raises (hip abductors)

1. Lie on your side with your left / right leg in the top position. Lie so your head, shoulder, knee, and hip line up. Bend your bottom knee to help with balance.
2. Lift your top leg 4–6 inches (10–15 cm) while keeping your toes pointed straight ahead.
3. Hold this position for __________ seconds.
4. Slowly lower your leg to the starting position.
5. Allow your muscles to relax completely.

Repeat __________ times. Complete this exercise __________ times a day.