Plica Syndrome Test

 Plica Syndrome Test

What is the Plica Syndrome Test?

Plica Syndrome Test is used to detect the presence of the plica in the knee joint and the irritation it produces.

See Also: Knee Plica Syndrome

How do you perform the Plica Syndrome Test?

Medial plica syndrome test:

Medial plica test (or Hughston Plica Test) is done with the patient lies in the supine position and the examiner grasps around the knee with one hand from an anterolateral position and presses the patella medially with the heel of the hand while palpating the medial femoral condyle with the fingers of the same hand. The examiner grasps the patient’s heel with the other hand, internally rotates the lower leg and then repeatedly flexes and extends the knee.

A painful audible or palpable “popping” suggests a mediopatellar Plica Syndrome.

Medial plica syndrome test
Medial plica syndrome test

Medial plica shelf test:

The patient lies in the supine position on the bed, with the knee supported in about 30 degrees of flexion by either a bolster or the clinician’s thigh. The clinician places both thumbs together at the lateral aspect of the patella and pushes the patella medially.

If a painful click is elicited during the Medial plica shelf test, there is likely to be a symptomatic mediopatellar synovial plica.

This pain, indicating a positive Plica Syndrome Test , is caused by pinching of the edge of the plica between the medial fem oral condyle and the patellar facet.

Medial plica shelf test
Medial plica shelf test

Knee Plica

Knee plica is a synovial folds that are embryologic remnants, they are occasionally pathologic, particularly the medial
patellar plica, which can cause abrasion of the medial femoral condyle and sometimes responds to arthroscopic excision.

Reportedly, these are medially based parapatellar bands in approximately 90% of symptomatic patients.

Knee Plica can sometimes be palpated as a palpable fibrous band running longitudinally between the patella and the medial femoral condyle. Flexion of the knee may tighten the plica over the medial femoral condyle and make it more prominent.

Arthroscopy is considered to be the gold standard for diagnosing knee plica, in one study by Vijay D Shetty found that arthroscopy confirmed the clinical diagnosis of medial plicae for a diagnostic accuracy of 91.7% and sensitivity of 100%.

Plicas can even cause arthroscopically visible evidence of chondromalacia of the edge of the femoral condyle

References

  1. Griffith CJ, LaPrade RF. Medial plica irritation: diagnosis and treatment. Curr Rev Musculoskelet Med. 2008 Mar;1(1):53-60. doi: 10.1007/s12178-007-9006-z. PMID: 19468899; PMCID: PMC2684145.
  2. Mayeda P: Ueber das Strangartige Gebilde in der Knigel–Enkhoehle (Chordi Cavi Artioularis Genu). Mitt Med Fak Kaisert Univ Tokyo 21:507–553, 1918.
  3. Zanoli S, Piazzai E. The synovial Plica Syndrome of the knee. Pathology, differential diagnosis and treatment. Ital J Orthop Traumatol. 1983 Jun;9(2):241-50. PMID: 6654660.
  4. Johnson DP, Eastwood DM, Witherow PJ. Symptomatic synovial plicae of the knee. J Bone Joint Surg Am. 1993 Oct;75(10):1485-96. doi: 10.2106/00004623-199310000-00009. PMID: 8408137.
  5. GRAY DJ, GARDNER E. Prenatal development of the human knee and superior tibiofibular joints. Am J Anat. 1950 Mar;86(2):235-87. doi: 10.1002/aja.1000860204. PMID: 15410671.
  6. Johnson LL: Diagnostic and Surgical Arthroscopy: The Knee and Other Joints. St. Louis, MI: C.V. Mosby, 1981.
  7. Ogata S, Uhthoff HK. The development of synovial plicae in human knee joints: an embryologic study. Arthroscopy. 1990;6(4):315-21. doi: 10.1016/0749-8063(90)90063-j. PMID: 2264900.
  8. Shetty VD, Vowler SL, Krishnamurthy S, Halliday AE. Clinical diagnosis of Medial plica syndrome of the knee: a prospective study. J Knee Surg. 2007 Oct;20(4):277-80. doi: 10.1055/s-0030-1248057. PMID: 17993067.
  9. Broom MJ, Fulkerson JP. The Plica Syndrome: a new perspective. Orthop Clin North Am. 1986 Apr;17(2):279-81. PMID: 3754943.
  10. Clinical Tests for the Musculoskeletal System 3rd Edition.
  11. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

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