Plica surgery is a type of minimally invasive arthroscopic surgery that is used to treat the injured medial plica in the knee joint and help relieve the painful and debilitating symptoms being caused by it. Plica syndrome is a condition that occurs when an otherwise normal structure in the knee becomes the source of pain as a result of overuse or an injury.
Plica is a band of synovial (soft) tissue that forms the inner lining of the knee joint and forms a fold due to excessive tissue so as to allow unrestricted movement of the knee. This tissue covers all the parts of the knee joint. There are a total of four plica synovial folds in the knee but an injury or damage is seen only to one particular tissue called the ‘medial plica’. This tissue connects the lower end of the knee cap (patella) and turns sideways to connect the lower end of the thighbone at the inner side.
Causes of Plica Syndrome
A plica syndrome is caused due to constant irritation, damage or an injury to the medial plica found in the knee joint. Certain repetitive exercises and motion used in sports such as running, biking, etc that require flexing the knee joint constantly can damage the medial plica and cause the plica syndrome.
Signs and Symptoms of Plica Syndrome
A plica syndrome is also caused when a traumatic injury damages the medial plica in the knee joint. This type of damage to the plica can make the knee tender to the touch and may also show signs of swelling.
It can also develop gradually over time with the use of repetitive motions for a long period of time (often seen in certain sport activities).
A plica syndrome causes severe pain in the knee area. You may also feel a ‘snapping sensation’ in the inner side of the knee joint when it is bent. This is causes due to rubbing of the swollen plica against the round edge of the thighbone as it enters the joint. It causes the plica to become tender to the touch as well as being generally painful. Plica syndrome due to an injury can also result in a swollen knee.
Diagnosing Plica Syndrome
The diagnosis for plica syndrome begins with the checking of your medical history as well as a complete physical examination. The physical examination is used to determine the location of the pain as well as the swelling on the medial plica.
In order to confirm the presence of a plica syndrome the doctor will conduct additional tests such as magnetic resonance imaging (MRI) test to view the soft tissues of the knee for any kind of injury in the meniscus or the ligament. A computerized tomography (CT) scan can also be suggested by the doctor to check the thickness of the damaged plica.
If the diagnostic tests help in positively identifying the presence of a plica syndrome the doctor is likely to suggest an arthroscopic (minimally invasive surgical procedure) method to treat the problem in the best way.
Most people with plica syndrome are likely to get better on their own with the passage of time as the main aim of the plica surgery is to decrease the swelling in the damaged plica which also requires limiting the extent of daily physical activities.
There are several different methods to treat plica syndrome, such as:
Non-surgical treatment methods for treating plica include administering anti-inflammatory drugs to reduce the swelling in the medial plica of the knee. Ice packs and ice massage are often suggested as non-surgical treatment methods for plica syndrome.
Another method of treatment involves planned doses of ‘cortisone’ injections into the plica, or the knee joint, which helps decrease the inflammation around the knee joint.
If the other non-surgical treatment attempts are unsuccessful in treating the plica syndrome the doctor might suggest a surgical treatment for it. Normally, a minimally invasive surgical method (arthroscopic surgery) is used to treat plica syndrome.
The surgery begins with the administering of local anesthesia in most cases to numb the knee area and to prevent pain or discomfort to the patient during the surgical procedure. After the anesthesia the doctor will make a few (2-4) very small (keyhole) incisions around the affected knee joint. One of these incisions is used to insert the arthroscope, which is a thin and flexible surgical tube equipped initially with a light-source and video camera at one end. This arthroscope is guided towards the damaged medial plica and gives the surgeon an unobstructed and magnified view of the damage. After having assessed the damage the surgeon will use other special miniaturized surgical equipments attached to the arthroscope to excise (cut) the damaged tissue and remove the complete structure altogether. The space left by the removed tissue is eventually filled by scar tissue and no complications have been reported till date due to a missing plica.
Risks associated with Plica Surgery
As is seen in any form of major surgical procedure the plica surgery treatment may also exhibit certain risks and complications related to the surgical part, such as:
- Anesthetic allergy
- Blood clot
The doctor/surgeon will adopt every possible precautionary measure to ensure that the risks and complications associated with plica surgery can be prevented.