Plica syndrome of the knee occurs when synovial tissue bands become irritated from injury or overuse. Pieces of synovial plica are remnants from early fetal development. These plica are membranes that should normally diminish during the second trimester of fetal development. When the pouches do not combine to form a synovial cavity, the plica remain in the knee as bands of synovial tissue.

Plica syndrome of the knee is associated with chronic overuse, inflammatory conditions, and knee injury. The medial plica is one of the four plica that are found in the knee. This piece of the lower end of the kneecap runs sideways and attaches to the lower aspect of the thighbone.

How does a plica cause problems in the knee?

A plica that becomes irritated causes knee pain. This occurs as a result of repetitive motions, certain exercises, or from kneeling. Any activity that causes repetitive bending and straightening of the knee can cause knee plica syndrome, such as stair-climbing, running, or biking. When the knee is struck near the medial plica from a fall or car accident, knee plica syndrome can develop. These types of injuries cause the plica and the tissue around it to swell and become painful.

What are the signs and symptoms of plica syndrome?

The main symptom of plica syndrome is pain. There is frequently a snapping sensation along the inside aspect of the knee when it is bent. This is caused by the rubbing of the thickened plica over the edge of the thighbone where it enters the joint. The knee may also be tender to touch and swollen.

How is plica syndrome diagnosed?

The orthopedic specialist diagnoses plica syndrome during a physical examination or at an arthroscopic surgery procedure. X-rays, a CT scan, and/or a MRI may be done to rule out other problems. X-rays rule out fractures, and the MRI shows soft tissue injuries. The CT scan can detect a thickened plica in some cases. To confirm the diagnoses and treat the problem at the same time, the orthopedic specialist may perform an arthroscopy.

What is the treatment for plica syndrome?

Our orthopedic specialists treat plica syndrome by resting the knee joint and with anti-inflammatory medications. If these conventional measures do not ease the pain of the knee, the doctor may inject cortisone into the joint.

Cortisone is a powerful anti-inflammatory agent. For serious cases of plica syndrome, surgical removal of the plica may be necessary. This procedure is done with an arthroscope, using a small camera and tiny instruments to remove the inflamed tissue.

The area left once the plica is removed heals with minimal scarring. Plica resection is often needed. The goal of treatment is to reduce the inflammation and restore function.

What is involved with the rehabilitation process?

If your doctor treats you non-surgically, you should return to normal activity within 4 to 6 weeks. It may be necessary for you to see a physical therapist during this time to learn stretching and strengthening exercises.

Other therapies include friction massage, ultrasound, and ice applications, all done to decrease the inflammation associated with plica syndrome. If you have surgery, you will need physical therapy to help you regain strength and function.

A fracture is a broken bone. These types of injuries occur when there is physical force exerted on the bone. Broken bones are common during childhood. Also, as you age, your bones become more stiff and delicate and you are more susceptible to fractures. There are several types of fractures, but the main categories are displaced, non-displaced, open, and closed.

… read more

The knee is a complex joint that is vulnerable to a variety of injuries. The knee is made up of the femur (the thigh bone), the tibia (the shin bone), and the patella (the knee cap). The femur rotates on the upper end of the tibia and the patella fits on the end of the femur.

There are also many large ligaments that connect the bones of the knee and help control knee motion. The meniscus is a wedge of cartilage that serves as a cushion between the femur and tibia and also absorbs shock. Many football athletes experience injuries to these knee structures.

Ligament Injuries

Football players frequently injure one or more of the knee ligaments. These ligaments include the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL).

• ACL Injury – When an athlete changes direction rapidly, lands wrong from a jump, or simply slows down when running, the ACL could tear. With this injury, knee swelling immediately occurs and walking is painful. The knee may have loss of range of motion and tenderness with an ACL injury. Treatment for this type of injury depends on the degree of tear to the ligament, whether or not there are other associated injuries, and how much physical demand the patient puts on their knee. Sometimes, the orthopedic specialist needs to operate to repair a complete tear of the ACL. Recovery is measured in months, rather than weeks for this type of injury.
• MCL Injury – The MCL is generally injured from a direct blow to the outside portion of the knee. The ligament is torn or stretched when the foot is planted firmly on the ground and a sideways force hits the knee. An injured MCL causes pain, difficulty walking, and tenderness. Therapy involves the use of a knee immobilizer, rest, ice applications, compression with a support bandage, and frequent knee elevation. Surgery is only necessary for severe tears of the MCL.
• PCL Injury – The PCL is injured when a football player receives a blow to the front aspect of the knee or makes a simple misstep on the turf. Most PCL tears and injuries will heal with conservative treatment. An injured PCL leads to pain with walking, instability, and swelling of the knee. Surgery may be necessary with complete tearing and extensive damage to the PCL.
  LCL Injury – The LCL is the least likely ligament to be injured during football activities. When severe force is applied to the inside of the knee, a LCL injury could occur. Symptoms include pain, swelling, weakness, tenderness, and discomfort to the outside of the knee. Treatment involves the RICE method, anti-inflammatory medications, and immobilization. Surgery to reattach the ligament to the bone is sometimes required.

Cartilage Injuries
Torn Cartilage – Most of the time, the meniscus is the cartilage that is torn during a football game. This rubbery, tough structure serves as a shock absorber during athletic activities. The meniscus tears with cutting, decelerating, pivoting, twisting, or from being tackled. Most torn meniscus injuries cause gradual pain and swelling, worse with climbing steps or uphill.

Not all meniscus tears require surgery, but frequently the damage can only be repaired through an operation.

Fractures
The patella can break if the football player falls directly onto it or receives a direct blow in that area. If the bone is fragmented, surgery will be required for repair. If the bone is in appropriate position, the orthopedic specialist may prescribe an immobilizer and rest for the injury.

The head of the fibula on the outside area of the knee joint is easily fractured from direct blows or as part of an injury to the lower leg. If the bone is not out of alignment, immobilization and conventional therapy will treat the injury.

Sometimes, however, the fibula fracture is complex and requires surgical repair. With jumping types of injuries, the tibia bone can be damaged. If the fracture occurs in the tibial plateau, surgery is often necessary.

Bursa Inflammation
Bursa inflammation is also called ‘housemaid’s knee’ or prepatellar bursitis and is the result of repetitive kneeling or crawling on the knees. The space between the kneecap and skin is called the bursa and it becomes irritated and fills with fluid. Bursa inflammation is a common type of knee injury of football players. Treatment includes using anti-inflammatory medications and rest. Occasionally the bursa needs to be drained for resolution of the problem.

Patellar Injuries
The patella can dislocate if it receives a direct blow. The blow can force this bone toward the outside area of the knee. Most dislocations of the patella easily return to normal alignment by simply straightening out the knee. However, some patella dislocations are serious and require surgery.

Also, patella-femoral syndrome is inflammation to the underside of the patella. This condition causes localized pain, which is worse with running and walking down stairs.

Treatment involves strengthening exercises, the use of ice therapy, and anti-inflammatory medications. Severe cases of this disorder require arthroscopic surgery to remove the damaged cartilage and realign parts of the quadriceps muscle.

Muscle and Tendon Strain
Most strains of the knee are treated with rest, ice therapy, elevation, and compression. Crutches help with walking, and the doctor may order an anti-inflammatory medication. These injuries are often the result of hyper-extension involving the hamstring muscles or hyperflexion causing the quadriceps to be injured.

If the patellar or quadriceps tendon is ruptured, there is inability to extend the knee. Surgery is necessary to repair this type of injury.

Football is a rough sport, regardless of the protective equipment worn. Injuries go with the territory when it comes to this sport. Because the players are big, the game is fast, and the nature is physical, football injuries are quite common. In the United States alone, there are an estimated 1.2 million football injuries each year, and around 50 percent of these injuries occur during training. … read more