The plica syndrome.

The plica syndrome is an uncommon pathologic entity diagnosed far too often in the setting of concomitant pathology. Medial patellar pain is more likely to be related to patellofemoral maltracking than to plica syndrome. Likewise, anteromedial joint line tenderness is more likely to be related to a meniscal tear than to a pathological plica. An accurate history and physical examination aided by appropriate ancillary tests to confirm the diagnosis are essential to avoid unnecessary surgical treatment. Conservative measures are very effective and must be emphasized before any operative procedure. When arthroscopy is indicated, a thorough examination of the entire knee joint is necessary. A plica may or may not be present. When a pathological plica is found, excision is rewarded with excellent results. Unfortunately, many normal plicae are removed simply because they are present and not because they are symptomatic or pathologic. This leads to persistent symptoms because of misdiagnosis, as well as possible complications secondary to the operation.