Pain in front of knee, side of knee along with cracking and popping sound: Plica syndrome

Synovial plica is an inward fold of synovial lining which is present in many people since birth. In the normal state, they are thin, pliable, and appear almost transparent, depending on its position, size and elasticity. The plica may impinge between the quadricep tendon and ends of the thigh bone. At the time when person bends the knee , causing mechanical symptoms.The pathological plica which has been through inflammatory process alters the pliability of synovial tissue and becomes more elastic, thight, thickend, fibrotic and sometimes hyalinized. Such plica gets impinged between patella and femur while doing knee flexion, which leads to the experience of non-specific pain in the front and the inner side of knee joint.

PATIENT EXPERIENCES- Aggravation of symptoms with overuse or heavy activities. This involves bending and straightening of knee joint. This is more common among the people who have poor quadricep tone or have any significant muscle imbalance around the knee joint. Mostly prolonged flexion of knee can initiate pain which can be a situation when sleeping at night and can be troublesome for people.


  1. History- Doctor interviews the patient to figure out the nature of symptoms, the course of time patient is experiencing discomfort and even other details related to the problem.

  2. Physical examination- This comprise of palpating the structures around the knee joint. Basically doctor looks for the area of tenderness, pain , noise in the knee cap bone and to perform physical diagnostic test that doctors are specialized in performing.

  3. Investigation- In Order to confirm the diagnosis doctor can ask for further investigation, which includes, Ultrasound scan of knee, CT scan of knee or even sometimes arthroscopy.


Management of plica syndrome is basically of two types. One is Conservative management and another is the surgical management.

Conservative management: The first thing in conservative management is Activity modification. Avoiding or changing the way of doing activities that can cause aggravation of the symptoms. Another thing is prescription of Non Steroidal anti inflammatory medications, pain killers, RICE regime which is the acronym of REST, ICE , COMPRESSION AND ELEVATION .There is this rare use of intraarticular steroid injections. This is followed by physiotherapy which comprise of use of electrotherapy like Ultrasound, IFT, TENS. along with this physiotherapist also prescribe exercises to strengthen the quadricep muscles and stretching of hamstring muscle also called as back thigh muscle. Sometimes taping techniques and stabilizing knee brace are used to enable proper movement of knee cap bone.

Surgical management:

Patient who are not able to experience significant improvement despite the conservative management for around 3 to 6 months, needs further investigation and management. The surgical management comprise of arthroscopy of the joint followed by resection of plica.

Meghana DaveComment