Arthroscopic Excision of Medial Knee Plica: A Meta-Analysis of Outcomes

Abstract

PurposeA meta-analysis was performed to assess the outcomes following surgical intervention for medial knee plica.Materials and MethodsA literature search of Medline, EMBASE, CINAHL and Cochrane CENTRAL was performed using relevant key words. The primary outcome was patient-reported postoperative scores of “good” and “excellent”. Meta-analyses were performed using a random effects model.ResultsThe literature search identified 731 articles. After removing duplicates and those not meeting the inclusion criteria, 12 articles reporting on a total of 643 knees were included for analysis, and of these, 7 articles including 235 knees were used for meta-analysis. The overall rate of good and excellent outcomes following surgery was estimated at 84.2% (95% confidence interval [CI], 72.8–91.4). In those cases that had non-surgical therapy prior to surgery, the rate of good and excellent outcomes of surgery was estimated at 76.1% (95% CI, 60.1–87).ConclusionsArthroscopic surgical management of symptomatic medial knee plica results in favourable outcomes. Our results suggest that arthroscopic surgical excision should be considered as a treatment modality in patients with pathological medial plica disease of the knee either as a first-line treatment or when symptoms have not responded to non-surgical interventions.Level of EvidenceIV

Reduplicated Medial Parapatellar Plica: a Case of a Medial Plica Anatomical Variation Recalcitrant to Conservative Treatment

“…The presence of a type C and D medial parapatellar plicae has been associated with conservative treatment unresponsiveness, longer duration of symptoms, and associated patellofemoral cartilage injuries such as the patient presented in the current case report [10]. A meta-analysis by Gerrard et al [5] reported favorable patient outcomes in medial parapatellar plica syndrome patients undergoing arthroscopic excision after failed conservative treatment. In the present study, arthroscopic media plica excision led to complete symptoms resolution at one month postoperatively, and the patient was then allowed to return to full activity, with no recurrence at the last follow-up, one year postoperatively.…”

“…However, the most accepted theory establishes the development of menisci, cruciate ligaments, and a partitioned joint cavity in the eight-week fetus, with the subsequent fusion of the joint knee compartments and resorption of the synovial septum by the end 12th week. In cases of incomplete resorption of the synovial septum, residual mesenchymal tissues result in the knee plicae [5,6,12,13,19,26].…”

“…The superior extremity arises from the suprapatellar plica or neighboring synovial tissues, while its inferior extremity expands to the infrapatellar fat pad. Thus, the plica lies between the medial patellar articular surface and the medial femoral condyle [5,8,9,17,23,25]. Histologically, it shows brous and chronic in ammation characteristics, most probably due to repetitive trauma during knee motion [2].…”

“…The plicae engage with the medial femoral condyle between 30-60° of knee exion, starting with the inner ap of type D plica and even locking into the patellofemoral joint [10,14]. This repetitive motion results in tenderness, swelling, snapping, locking sensation, potential chondral injuries, and further degeneration in the patellofemoral joint [5,10,12,13].…”

“…It runs obliquely from the medial knee capsule to the synovium of the infrapatellar fat pad [3,23]. Mayeda described it for the rst time in 1918 and has been named with a vast terminology: Iino's band, chorda cavi articularis genu, shelf, plica alaris elongata, plica synovialis mediopatellaris, among others [5,21,23].…”