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Monday, September 1, 2014
Plica syndrome vs torn meniscus
Can an MRI differentiate between Plica Syndrome and a torn meniscus? I have had an MRI and have been diagnosed as having a torn medial meniscus. I was even shown the tear in the image and it looks just like the textbook reference pictures for MRIs of torn menisci plastered on the Internet. A running friend suggested asking my doctor about Plica Syndrome as he was misdiagnosed as a meniscus tear when in fact that was not his issue. I thought the MRI was a definitive test though. I have found numerous references as to the similarities of the symptoms between the two injuries, but I am yet to find any information on diagnosing one from the other. Please respond with any information. Thank you.
A "plica syndrome" - pain in the front (anterior) and inner (medial) aspect of the knee due to repetitive rubbing of a fold of synovial tissue which lines the inside of the knee joint - is usually diagnosed clinically (by history and physical exam) rather than by MRI. A plica which causes symptoms may not necessarily show up on a knee MRI scan, but not every plica causes symptoms. Knee MRI is very good at detecting meniscal tears, but does not indicate whether a meniscus tear is symptomatic (causing pain or instability symptoms), because some meniscal tears cause no symptoms.
You are correct in stating that the symptoms for these two conditions may be similar, but findings on physical exam help distinguish one from the other, specifically:
1) the exact location of maximal tenderness, and
2) if a click or snapping phenomenon can be elicited, exactly which maneuver is used to do this: if due to a symptomatic plica, this usually occurs between 50 to 70 degrees of knee flexion (with respect to a fully extended knee starting position), whereas with a symptomatic meniscal tear, any click is usually elicited with the knee near full flexion - meaning at or beyond 120 degrees of knee flexion.
Keep in mind that surgery for a suspected symptomatic plica is not without potential complications (see response to question submitted 2/23/01).
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University