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E Guidelines A-Z Index A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Entitlement Eligibility GuidelinesChronic Plica Syndrome
DefinitionA plica is a synovial fold, pleat or band, identifiable within the knee joint, and classified into suprapatellar fold, medial fold, and an infrapatellar fold which may lead to signs/symptoms which are identified as Plica Syndrome. The existence of plica alone is not a "disability" for VAC pension purposes. It may lead, however, to signs and/or symptoms, which are identified as "plica syndrome" (see Clinical Features). Please note: Entitlement should be granted for a chronic condition only. For VAC purposes, "chronic" means that the acute condition has existed for at least 6 months. Signs and symptoms are generally expected to persist despite medical attention, although they may wax and wane over the 6 month period and thereafter. Back to TopDiagnostic StandardDiagnosis by a qualified medical practitioner is required, supported by results of clinical examination. Plica is usually demonstrated through arthroscopic surgery. Back to TopAnatomy and PhysiologySynovial plicae are folds of embryonic remnants of the synovial membrane. In the fetus, thin synovial membranes divide the knee joint into three compartments: medial, lateral and patellar. In the fifth month of fetal development, the partitions usually degenerate and the knee joint becomes one cavity. Incomplete degeneration of one or more of the membranes can result in the formation of plicae. Most synovial folds contain a considerable amount of elastin and areolar tissue, and are, therefore, extensible and asymptomatic. Many are detected during routine arthroscopic procedures performed for other reasons, and are often an incidental finding of uncertain clinical significance. Plicae can be found anywhere in the knee joint. The medial suprapatellar plica and the less common lateral suprapatellar plica are the most prominent. Plicae over the medial femoral condyle are called medial, or shelf, plica. This is the area most susceptible to trauma and subsequent irritation. When the knee is extended, the patella protects the interior aspects of the femoral condyles; however, when the knee is flexed, the medial condyle is more vulnerable. Inflammation of the plica with subsequent thickening from various causes may produce local irritation and erosion on the underlying hyaline cartilage on the condyle. Back to TopClinical FeaturesCareful examination may be required to differentiate symptoms of a thickened plica that becomes inelastic from fibrosis or hyalinization from symptoms of a torn meniscus. A pathological plica produces popping and catching in the knee by snapping across the patella or medial femoral condyle, usually at repeatable positions when the knee is extended or flexed. Medial plica can be palpated, and some are tender. They are located above the joint line. Palpation of the condyle next to the patella while a person is flexing and extending the knee may produce a snap or click. Any condition that produces chronic irritation, trauma, or scarring of the fold of synovium may result in thickening of this structure and the production of signs and symptoms. Back to TopPension Considerations
References for Chronic Plica Syndrome
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