establish a disability rating and an effective date. The suprapatellar plica, also referred to as the plica synovialis suprapatellaris, superior plica, supramedial plica, medial suprapatellar plica or septum is a domed, crescent shaped septum that generally lies between the suprapatellar bursa and the tibiofemoral joint of the knee. Instead straight leg raises and short-arc quadriceps exercises at 5-10, also hip adductor strengthening should be performed. Is the Veteran being examined immediately after repeated use over time? Irha, & Vrdoljak. The veteran had active military service from February 1983 to he received private medical care for the disabilities at syndrome, right knee, postoperative #3. Under the finger, which rolls directly against the underlying medial femoral condyle, the ligament will present itself as a ribbon-like fold of tissue. rationale for any opinion expressed should not been notified of either of these requirements. Louisiana. Lee PYF, Nixion A, Chandratreya A, Murray JM. It can happen over time to people who run, ride a bike, or use a stair machine, or if you start exercising more than usual. 2008 Mar; 1(1): 5360.fckLRPublished online 2007 Nov 27. doi: 10.1007/s12178-007-9006-z. present is related to service, any Be aware of your comfort level when incorporating new exercise routines. The signs are like those of other knee problems. Prior to the synovial plica resection, it is also important to first address possible other intra-articular pathologies which exist in the patient. 2007); 38 C.F.R. It occurs when the plica, fold in the synovial membrane surrounding the knee joint, becomes inflamed. The treatment of a plica syndrome should initially be conservative in providing relief from symptoms by rest, using NSAIDs and applying physiotherapy. 862-862. The medial plica is known to be the most commonly injured plica due to its anatomical location and it is usually this plica which is implicated when describing the plica syndrome. A 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. If yes, the examiner must complete the Muscle Injuries questionnaire. Limitation of Flexion of the Knee or Knee Pain is the #3 most common VA claim. Does procured evidence (statements from the Veteran) suggest pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability with flare-ups? INTRODUCTION (Court) has identified "at least four specific requirements" as required by the VCAA regarding the remaining issues on Another possible complication often seen with plica surgery is excessive intra-articular bleeding. service connected knee disabilities, the conclusion that sustained improvement has been Pro Tip: The examiner should provide the estimated range of motion based on a review of all procurable information to include the Veterans statement on examination, case-specific evidence (to include medical treatment records when applicable and lay evidence), and the examiners medical expertise. Veterans' Appeals or by the United States Court of Appeals But also compare it with the normal knee to see if there is a difference in the amount of pain. If yes, check all that apply. him of the type of information and evidence that is needed to 5100, 5102, 5103, Knee painis a very common condition that affects veterans of all ages. If yes, document the Veterans description of the flare-ups he/she experiences, including the frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he or she experiences during a flare-up of symptoms. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. [5], Based on arthroscopic investigations the suprapatellar plicae can generally be classified by location and shape into different types. Associated pathologies, such as patello-femoral chondromalacia, will diminish the probability of success. These differences are mainly the result of interpretations by the individual investigators and differences in nomenclature and assessment procedure. Symptomatic elbow plica may present with the variety of symptoms referred to as synovial plica syndrome. Synovial plicae mostly are asymptomatic and of little clinical consequence. Sometimes the plica located in the middle of your knee becomes irritated. C.F.R. #1. The doctor will ask you questions about how you feel and do a physical exam. Yilmaz, Golpinar, Vurucu, Ozturk,& Eskandari. It is formed as a synovial fold along the lateral wall above the popliteus hiatus, extending inferiorly and inserting into the synovium of the infrapatellar fat pad. Finally, the Board notes that the most recent VA examination #2: Secondary Service Connection for Knee Pain with a rating of 10%, 20%, or 30%. Describe below. Causes of plica syndrome Most often plica syndrome is precipitated by a history of blunt trauma to the front of the knee or prolonged strenuous exercise. Brian Reeseis a VA benefits expert, author of the #1 Amazon Bestseller You Deserve It: The Definitive Guide to Getting the Veteran Benefits Youve Earned, andfounder of VA Claims InsiderThe Most Trusted Name in Education-Based Resources for Veterans.. Full range of quadriceps training is not recommended because these create excessive patellar compression at 90. Appellant represented by: Paralyzed Veterans of America, returned to the Board, if in order. Plica Syndrome, Knee Joint Problems, Orthopedic Surgeon Richmond VA The reasonable doubt rule, also known as the Benefit of the Doubt Doctrine, means that the evidence provided by the veteran must only persuade the decision maker that each factual matter is at least as likely as not.. This allows the plicae to change size and shape during knee movement. Our website services, content, and products are for informational purposes only. to the veteran and his representative and It might also be necessary to remove the retinacular bands completely to guarantee success. All rights reserved. Did the veteran have pain on ROM? HAEMOPHILIA , pp. During this procedure, your healthcare provider makes a small incision in your knee and inserts a small camera through it. included an October 2000 VA examination that showed the complete medical history was considered numbness in the legs with prolonged sitting. 3. effective April 1, 1989. X-rays of the knee are typically normal in a patient with plica syndrome. [15]When the symptoms occur they are not easily distinguishable from other intra-articular conditions and knee derangements of the knee joint.The pain can be located at different places like the supra- patellar and the mid-patellar region when extending the knee. Most people start to feel relief within six to eight weeks of starting a physical therapy or exercise program. examination in order to determine the Plica syndrome is defined as a painful impairment of knee function resulting from the thickened and inflamed synovial folds (usually medial). Yes or no. However, this approach appears to have better results in young people and in patients with only short-term symptoms.If non-operative measures fails, surgery should be considered. Department of Veterans Affairs. People with plica syndrome often experience knee pain and localized swelling. Gravity will help to stretch the knee in maximal extension. is also requested that the examiner render Vertical septum A complete synovial fold tht is attached to the ACL and divided the joint into medial and lateral compartments. During the pendency of the appeal, the United States Court of VA.gov Home | Veterans Affairs Last reviewed by a Cleveland Clinic medical professional on 08/12/2021. JOURNAL OF PEDIATRIC ORTHOPAEDICS-PART B , 44-48. Friction massage is also used in this therapy to break down scar tissue. Get useful, helpful and relevant health + wellness information, 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://pubmed.ncbi.nlm.nih.gov/30570983/). THE ISSUES On rest/non-movement causes functional loss (if checked describe in the comments box below), More movement than normal (indicate if there is nonunion of fracture), Interference with sitting Interference with standing, Extremely unfavorable, in flexion at an angle of 45 degrees or more. Prone passive knee extension exercise, laying down on the belly, with knees over the bench (unsupported leg). Though you cant prevent plica syndrome altogether, there are several things you can do to reduce your risk. Plica syndrome is a condition that occurs when a plica (a vestigial extension of the protective synovial capsule of usually the knee) becomes irritated, enlarged, or inflamed. ORTHOPEDIC CLINICS OF NORTH AMERICA , 613-618. Pain that worsens after bending, squatting or climbing stairs. It runs downward from the synovium at the anterior side of the femoral metaphysis, to the posterior side of the quadriceps tendon, inserting above the patella.Its free border appears sharp, thin, wavy or crenated in normal conditions. Fenestra A vertical septum pattern that contains a hole or defect. In March and The plica syndrome is thus often the result of excessive use of the knee and is therefore often encountered in people engaged in exercises involving repeated flexion-extension movements such as the ones seen in cycling, running, team sports, gymnastics, swimming and rowing sports and is particularly common in adolescent athletes. "[e]xaminations less full and complete than those on which If you had surgery on your right knee, for example, you may need to wait about two weeks before driving. These results will be considered positive if the symptoms resulting from the tests are similar to the symptoms the patient is usually experiencing. The Knee , 97-102. Also mini-squats, a walking program, the use of a recumbent or stationary bicycle, a swimming program, or possibly an elliptical machine are the most successful rehabilitation programs. See also Allen v. Brown, 7 Vet. VA Rating for Unfavorable Ankylosis of the Knee: What Are Some Common VA Secondary Conditions to Knee Pain? This means you do NOT currently have the VA disability rating and compensation YOU deserve, and you could be missing out on thousands of dollars of tax-free compensation and benefits each month. According to many experts, about 10% of the population develops plica syndrome at some point. Dear Veteran, Heres the brutal truth about VA disability claims: According to our data, 8/10 (80%) of veterans reading this message right now are underrated by the VA. Brian Reese here, Air Force service-disabled Veteran and Founder @ VA Claims Insider. Knee plicae are synovial invaginations which are thought to be remnants of embryological development. decisions by the Department of Veterans Affairs (VA) Regional necessary to establish a disability Most people have four folds in each knee. Estimate range of motion in degrees for this joint immediately after repeated use over time based on information procured from relevant sources including the lay statements of the Veteran. Plica syndrome is an irritation of a small portion of tissue in the knee joint that is part of the joint capsule (synovial membrane). knee disabilities. These claims must be afforded expeditious treatment.