Overuse Injuries

Plica Syndrome

A plica is an extra fold of tissue lining the inside of the knee. It is usually found on the inner side of the joint. Having a plica is a common occurrence and the majority of people who have plicae do not have symptoms. It is often found incidentally during a knee arthroscopy (keyhole procedure).

‘Plica syndrome’ is a condition which occurs when a normally thin plica becomes irritated, enlarged, or inflamed. This most often happens as a result of repetitive ‘bent knee’ sports e.g. cycling. The thickened plica can then catch on the front of the thigh bone during knee flexion (bending).

Treatment of plica syndrome initially focuses on reducing the local inflammation.

Non-steroidalanti inflammatories (NSAIDs) are often used in conjunction with various physiotherapy techniques. In rare resistant cases a knee arthroscopy and surgical excision of a plica is necessary.

Ilio-tibial Band (ITB) Friction Syndrome

ITB friction syndrome is a relatively common cause of lateral (outer) knee pain and localised swelling. It is usually seen in runners and active people and is caused by an inflammation of the ITB tendon as it crosses the outer side of the knee joint (femur) before inserting into the top of the shin bone (tibia).

The cause is often due to the underlying anatomy (“the way you are made”) together with ‘overuse’. It frequently presents after patients increase their running mileage when in training for an event.

Tight hips, bow legs and flat feet have all been implicated in causing ITB symptoms. Diagnosis is usually from the history (story) and examination but can be confirmed with an MRI scan which sometimes shows the inflamed area. The vast majority of cases are successfully treated with non-operative measures which include anti-inflammatories, rest, stretching techniques and localised physiotherapy.

If the symptoms do not settle, a steroid injection may be used or a small surgical releasesettle a small surgical release of the tight ITB can be performed.