Symptoms
At the beginning of the syndrome, symptoms occur during heavy physical exertion, such as climbing stairs or hiking in the mountains. If the syndrome is advanced and the bone is increasingly exposed, symptoms may also occur at rest. In the case of incarcerations, acute symptoms occur immediately, which can be very severe.
In this case, the patient feels pain in the sense of knee flexion even under light load. The diagnosis of a plica syndrome is difficult. In addition to the physical examination, during which above all diseases of the meniscus and the ligamentous apparatus are excluded, which can lead to similar complaints, imaging diagnostics should always be performed.
Since a normal x-ray examination of the knee mainly shows bony changes and less the soft tissues, the simple x-ray is rather not the method of choice. Instead, magnetic resonance imaging (MRI) of the knee is used. There, the space conditions in the area of the knee joint can be displayed and it can be seen whether a plica is present.
If this is the case, it is also possible to assess whether the plica has become trapped in the joint space of the knee joint. Knee arthroscopy is also used as a diagnostic tool, in which a camera as well as instruments can be inserted into the knee joint through small skin incisions above the knee. The advantage of this method is that, on the one hand, real images of the knee joint are transmitted to the examiner and, on the other hand, the patient’s knee joint can also be moved during the examination.
Sometimes an existing plica can get stuck in the knee joint during flexion and slide back into normal position during extension. This could be easily detected during arthroscopy. Often the diagnosis of a plica syndrome is more of a differential diagnosis, if no disease belonging to the complaints can be seen. In general, an MRI examination is very helpful if the ligaments of the knee joint are to be visualized, since soft-tissue body structures are also well imaged. However, since the plica is often very unfavorably embedded in the joint, it cannot always be made visible by an MRI examination.In these cases, the diagnosis can be made either by a groundbreaking physical examination or ultimately only during the arthroscopy itself.
