In the Hughston test, the patient lies supine with the knee extended. The patient then extends the affected leg while the examiner feels for a stutter of the patella. The examiner places his or her index and middle fingers on the center of the patella of the affected leg. The Stutter test is performed by having the patient sit upright with the legs dangling off the edge of the exam table at a 90-degree angle. If only 1 of the 2 is positive, plica syndrome is less suspicious, but should still be considered. When both tests are positive, the diagnosis of plica syndrome should be suspected. These tests are the Stutter test and the Hughston test. Two physical exam techniques can suggest plica syndrome. Other findings on physical exam may include an effusion, tight hamstrings, and tight quadriceps. If this is the case, the contralateral knee should be examined to see if there is a plica causing tenderness to palpation on that knee as well. On physical exam, a taut band may be palpable under the skin which may be tender to palpation. These include hemarthrosis secondary to hemophilia, intra-articular lesions, loose foreign bodies, and rheumatoid arthritis. There are secondary causes of plica that should be considered when obtaining a history. The history may include a twisting injury or blunt trauma, or there could be no history of injury or trauma. Pain can be brought on by rising from a chair, squatting, stairs, or other activities that load the patellofemoral joint. The anterior knee pain is a hallmark of plica syndrome. Patients with plica syndrome will experience pain on the anterior aspect of the knee associated with clicking or popping. This inflammation can then lead to a tight, fibrotic plica that can manifest in symptoms during flexion of the knee when it leads to impingement between the patella and femur. Normal plicae can become painful as a result of undergoing inflammation. It is important to note that not all plicae cause pain. It is found between the infrapatellar region and the lateral patellar facet. The lateral plica is the rarest of the plica. Medial plicae are the most common type of plicae and are the most common to be symptomatic. The medial plica is found between the infrapatellar fat pad and the medial aspect of the knee joint. The infrapatellar plica is found between the intercondylar notch and the synovium around the infrapatellar fat pad. The suprapatellar plica is found between the knee joint and the suprapatellar bursa. It is not uncommon for a patient to have more than one plica. These are suprapatellar, infrapatellar, medial, and lateral. įor the approximately 50% of people who have a plica, there are four different normal plicae. Plicae typically involute when the fetus is around 12 weeks old, but autopsy results indicate plicae are present in 50% of individuals. Plicae are normal structures in the knee joint that come together in utero.
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