A medial plica is a remnant of an embryonic partition in the knee, and runs along the inner aspect of the kneecap.

medial plica

It may also be called a 'medial shelf' - more a vertical shelf than a horizontal one, mind - and runs down from above the patella to the fat pad below the patella.

As the knee bends the 'shelf' of tissue may also give a sudden snap over the rounded ends of the femur bone.

The patient may experience a sharp pain when the knee is in a certain position and the plica is being nipped.

Recurrent nipping traumatises and thickens the plica. When a medial plica becomes abnormally thickened, it can be felt with the finger as a string-like object to the inner aspect of the kneecap.

nipped plica

 

 

The inset in the illustration on the right is a photograph taken during arthroscopy of a medial plica. The camera ( arthroscope ) is in the suprapatellar pouch , looking down on the top of the patella. You can see the thickened plica becoming nipped between the patella (above) and the femur (below) - as demonstrated in the illustration.

A pathological (abnormal and symptomatic) plica is something that is often missed by surgeons, but in the right patient symptomatic relief can be immediate after its removal.

 

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