Disclosures: Shelby E. Johnson, MD: No financial relationships or conflicts of interest

Case Description: The patient presented with nine years of right anterolateral knee pain managed as patellofemoral pain syndrome. Symptoms started after a fall with subsequent hemarthrosis. Pain worsened with prolonged sitting, walking, and stair climbing. He described painful snapping, popping, and catching and intermittent lateral knee swelling. Physical therapy with home exercises was not helpful. Palpation-guided intra-articular corticosteroid injections provided minimal relief. Pain limited his walking and jogging. Exam demonstrated a tender suprapatellar fluid collection. Painful catching was reproduced with active and passive knee flexion. Patellar grind and patellar apprehension were negative. Ligaments were stable. Meniscal testing was negative. Radiographs demonstrated right knee synovitis. MRI demonstrated a 4.5×2.8 cm loculated fluid collection with rice bodies in the suprapatellar bursa consistent with a complete suprapatellar plica. Ultrasound re-demonstrated the large suprapatellar plica with synovial hypertrophy and chronic inflammatory changes about the plical tissue.

Setting: Tertiary outpatient clinic

Patient: 45-year-old male who presented with right anterolateral knee pain and mechanical symptoms Assessment/

Results: Given inflammatory changes on imaging, an ultrasound-guided aspiration of the plical fluid was performed. Three cc of bloody fluid was removed followed by an intra-plical corticosteroid injection. Fluid was negative for infection or systemic inflammatory condition. At 2-week follow-up, he noted significant pain improvement but persistent mechanical symptoms. He was advised that with continued mechanical irritation and given the chronicity of his symptoms, he may require surgical intervention for complete relief.

Discussion: Plicae are common incidental findings on imaging and arthroscopy but are rarely of clinical consequence, especially in the suprapatellar location. Symptoms are non-specific and often misinterpreted as patellofemoral maltracking or meniscal injury. Success of physical therapy and intra-articular or intra-plical corticosteroid injections is typically low, especially in chronic cases. Arthroscopic excision may be necessary.

Conclusion: This case highlights the importance of a complete evaluation of a patient’s presentation, especially when symptoms persist despite appropriate treatment.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/symptomatic-complete-suprapatellar-plica-a-case-report/