Mediopatellar Plica Test

Original Editor - Kehinde Fatola
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Purpose[edit | edit source]

Mediopatellar plica test is also known as Mital-Hayden test. It is used to identify pain originating from the medial patellar plica. [1]

Technique[edit | edit source]

[2]

The patient lies supine while the clinician/examiner stands on the side of the affected leg, the patient's knee is positioned at about 30° flexion which is then supported by the examiner. The clinician places their two thumbs on the lateral border of the patella. pressure is then applied with the thumbs on the patellar attempting to glide it medially. Provocation of pain is indicative of an inflamed medial patellar plica.

Clinical Context[edit | edit source]

Plicae are synovial tissue folds which are embryological in origin but may persist in some individuals. They are found at the medial, superior and inferior margins of the patella [3] and may be asymptomatic in some individuals. The medial patella plica consists of five folds of synovial tissue located between the medial border of patella and the medial femoral condyle, It is considered the most problematic causing up to 40° and 80° impingement in knee flexion. [4]

Diagnosis is generally difficult as there is no evidence of accuracy of different assessment methods of plica dysfunction, though it can look like classic meniscal symptoms, [5][4][6] therefore MRI is sometimes necessary to confirm the involvement of plica. This test can be reversed if symptoms emanated from the lateral side. Other tests, such as McMurray's and patellar apprehension tests may produce false positive result. [4][5] Tenderness and thickening may be present at the medial border of the patella over the medial femoral condyle.

Variations[edit | edit source]

Hughston plica test is performed with the patient lying supine, the knee taken to 30° and the tibia is internally rotated by one hand. The other hand is used to glide the patella medially while palpating its medial border to feel for a popping sound (crepitus) as the knee is being moved passively between flexion and extension which may be accompanied by pain or not. [7]

Plica stutter test is carried out with the patient in sitting position and the two knees flexed freely over the side of a couch, the margins of the patella are palpated to detect any stutter as the knee is actively extended from the initial flexed position which usually occur in the mid-range of motion. [7]

References[edit | edit source]

  1. Hattam P, Smeatham A. Special Tests in Musculoskeletal Examination. Edinburgh: Churchill Livingstone, 2010.
  2. San Pedro College - PT Department. Mediopatellar Plica Test. Available from; https://www.youtube.com/watch?v=Jl8oD_FsccI {accessed 04/03/2021)
  3. Hardaker, W.T., Whipple, T., Bassett, F., 1980. Diagnosis and treatment of plica syndrome of the knee. J. Bone Joint Surg. Am. 66, 221–226
  4. 4.0 4.1 4.2 Abrahams, S., Kern, J.H., 2001. Anterior knee pain: plica syndrome, the forgotten pathology? Physiotherapy 87 (10), 523–528.
  5. 5.0 5.1 Saengnipanthkul, S., Sirichativapee, W., Kowsuwon, W., et al., 1992. The effects of medial patellar plica on clinical diagnosis of medial meniscal lesion. J. Med. Assoc. Thai. 75 (12), 704–708.
  6. Tindel, N., Nisonson, B., 1992. The plica syndrome. Orthop. Clin. North. Am. 23 (4), 613–618.
  7. 7.0 7.1 Magee, D.J., 2008. Orthopaedic Physical Assessment, fifth edn. Saunders, Philadelphia.