Plica syndrome or patellofemoral pain: what is causing the ache at the front of my knee?

The short verdict

The two often look alike and can occur together, because overload of the front of the knee can irritate a plica too. Patellofemoral pain is the much more common diagnosis. A plica is a normal fold of the joint lining that most people have; it only causes trouble when it becomes thickened and inflamed. In both, the first treatment is a structured exercise programme, and surgery is needed only rarely.

How they compare

• Where it hurts: patellofemoral pain is around or behind the kneecap and hard to pinpoint; plica pain is usually a spot on the inner side of the kneecap
• Feel: plica syndrome may cause a tender cord-like band you can roll under your finger, and a snap or click when bending
• Triggers: both are worse on stairs, squatting and sitting with bent knees; a plica may also catch with repeated bending, such as cycling
• Swelling: unusual in both
• Imaging: often normal in both; an MRI may show a thickened plica but plicas are common in knees without any symptoms too
• Treatment: both respond to strengthening, load management and sometimes an injection; arthroscopic plica removal is considered only if months of good treatment fail

Who each tends to affect

Patellofemoral pain tends to affect teenagers and young adults, women more than men, runners, footballers, padel players and people who have increased training quickly. Plica syndrome tends to affect active adolescents and young adults, cyclists and rowers who bend the knee repeatedly, and people after a direct knock to the inner front of the knee. Long-haul flights and floor sitting can aggravate both.

When to see a knee surgeon in Doha

Book an assessment if front-of-knee pain persists beyond a few months of consistent exercise, if your knee swells, locks or gives way, or if the pain is getting worse. Dr. Gelber at Aman Hospital will examine the kneecap and the inner joint line, consider other causes such as a meniscus tear, and advise whether further rehabilitation, an injection or, occasionally, keyhole surgery is appropriate.