Hughston plica test is performed with the patient lying supine, the knee taken to 30° and the tibia is internally rotated by one hand. Tenderness and thickening may be present at the medial border of the patella over the medial femoral condyle. Other tests, such as McMurray's and patellar apprehension tests may produce false positive result. This test can be reversed if symptoms emanated from the lateral side. ĭiagnosis 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, therefore MRI is sometimes necessary to confirm the involvement of plica. 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. They are found at the medial, superior and inferior margins of the patella and may be asymptomatic in some individuals. Plicae are synovial tissue folds which are embryological in origin but may persist in some individuals. Provocation of pain is indicative of an inflamed medial patellar plica. pressure is then applied with the thumbs on the patellar attempting to glide it medially.

The clinician places their two thumbs on the lateral border of the patella. 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.

Medial pica syndrome