Characteristics of medial plica syndrome complicated with cartilage damage

Kan, Hiroyuki; Nakagawa, Shuji; Inoue, Hiroaki; Hara, Kunio; Minami, Ginjiro; Kanamura, Hitoshi; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

doi:10.1007/s00264-015-2782-y

Cited by 15 publications

(15 citation statements)

References 30 publications

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“…The excision of plica, after not responding to conservative treatment, yielded great symptom relief [10]. It is important to note that delay in treatment of medial Parapatellar plica syndrome will lead to cumulative chondral damage of the medial femoral condyle [8,9]. Arthroscopic debridement of medial Parapatellar plicae may hence play a role in controlling the progression of the mechanical and inflammatory processes that culminate in medial compartment osteoarthritis and subsequent need for arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Diagnostic Accuracy of Knee MRI in Detecting Medial Parapatellar Plicae versus Knee Arthroscopic Findings

Al-Taki¹,

Sukkarieh²,

Khoury³

et al. 2018

J Surg Anesth

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Background: Medial Parapatellar synovial plicae is a common cause of knee pain with a clinical presentation similar to meniscal tear but with a different pathophysiology. Plicae, an extension of the protective synovial capsule of the knee, are originally remnants of embryological folds inside the knee joint that fail to regress with time. Although benign in nature, plicae, when thickened, can impinge on the medial femoral condyle leading to pain. Magnetic resonance imaging is the non-invasive test of choice for detecting Parapatellar plicae.Objective: The objective of this study was to assess the specificity, sensitivity and diagnostic accuracy of MRI in detecting medial parapatellar synovial plicae as compared to knee arthroscopy findings.Methods: A retrospective review was conducted at the American University of Beirut Medical Center. Patients who underwent knee arthroscopy and were between 18 and 75 years of age were included. Data on age, gender, knee arthroscopy findings and preoperative MRI findings were abstracted. The diagnostic capability of MRI was assessed by calculating the sensitivity, specificity, positive predictive value, and negative predictive value. Results: 29 MRIs were read as negative and 52 were positive for the presence of medial Parapatellar plica. Out of the 23 negative MRIs, 14 (60.8%) had plicae as demonstrated during arthroscopy and 9 (39.2%) had no plica as confirmed during arthroscopy. Whereas 34.4% (20 out of 58) patients with arthroscopic demonstrated plicae had negative MRI readings, and 63.6% (38 out of 58) of patients with plicae demonstrated on arthroscopy had actual positive findings on MRI.Conclusion: MRI accuracy in detecting plica is insufficient compared to knee arthroscopic findings. This take home message might be a helpful tool for insurance company to acknowledge the limitation of MRI in diagnosing plica syndrome due to the significant probability of misdiagnosis.

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Section: Discussionmentioning

confidence: 99%

Assessment of Diagnostic Accuracy of Knee MRI in Detecting Medial Parapatellar Plicae versus Knee Arthroscopic Findings

Al-Taki¹,

Sukkarieh²,

Khoury³

et al. 2018

J Surg Anesth

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“…Types C and D are larger and were associated with worse cartilage damage from impingement compared with the smaller types A and B. 19…”

Section: Mediopatellar Plicamentioning

confidence: 94%

“…7 The several published classification systems of the mediopatellar plica are based on their arthroscopic appearances. 3,13,18 The more popular and clinically relevant classification is by Sakakibara, 3,10,19 who classified the plica into four types: type A (cord-like appearance), type B (small shelf-like appearance), type C (larger shelf-like appearance draping over and covering the medial femoral condyle), and type D (similar to type C but split at its origin from the medial wall; it therefore has two separate attachments) (►Fig. 3).…”

Section: Mediopatellar Plicamentioning

confidence: 99%

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Plicae: Where Do They Come from and When Are They Relevant?

Wong

Lalam

2019

Semin Musculoskelet Radiol

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Synovial plicae are vestigial folds of synovium in a joint, most widely recognized in the knee and also in the elbow and hip joints. The most commonly shared theory on the origin of plicae is that they are the remnants of the membranes that divide the synovial cavitations during normal joint development. Synovial folds do not generally cause any symptoms. However, they can become inflamed, thickened, fibrosed, and also impinged in the joint, leading to mechanical symptoms and chondral damage. This article presents an overview of the embryological origin of plicae, their anatomy, pathologies, and appearances on imaging. We also discuss the lesser known plicae in various other areas.

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“…The presence of plicae can lead to repetitive trauma, and in ammation compromising the cartilage of the medial femoral condyle, producing medial and/or anterior knee pain, snapping, and effusion, and referred to as medial parapatellar plica syndrome, mimicking meniscus tear or patellofemoral syndrome-like symptoms [10,14,25].…”

Section: Introductionmentioning

confidence: 99%

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

Fermín

Macchiarola

Tsakotos

et al. 2022

Preprint

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Purpose: The current study aims to report the radiologic and clinical appearance of a rare anatomical variation of the knee medial synovial plica along with its response to conservative and surgical treatment.Case presentation: This report portrays a 29 years old male patient with anteromedial gradual onset right knee pain, aggravated when descending stairs or prolonged sitting. Physical examination revealed medial parapatellar local tenderness, a palpable click in this area when the knee is extended, and hamstring tightness. Magnetic resonance imaging showed a duplicated medial plica, characterized by a high-intensity signal of the infrapatellar fat pad medial portion, after which a presumptive diagnosis of medial plica syndrome was proposed. After conservative treatment failure, the patient underwent standard knee arthroscopy that revealed a superior low profile and an inferior high profile medial plica, and hypertrophy of the medial portion of the infrapatellar fat pad. Both plicae and fat pad were resected with a mechanical shaver until no contact between the femoral trochlea and the fat pad was observed during full range of motion. At four weeks postoperatively, symptoms completely resolved, and the patient was allowed to return to full activity with no recurrences at one-year follow-up.Conclusion: The current study presented a rare anatomical variation of the knee medial synovial plica that was symptomatic and recalcitrant to conservative treatment. This case report may be useful for radiologists and orthopaedic surgeons to differentiate this special plica type and consider its response to conservative and surgical treatment during patient management.

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Characteristics of medial plica syndrome complicated with cartilage damage

Abstract: Level IV.

Cited by 15 publications

References 30 publications

Assessment of Diagnostic Accuracy of Knee MRI in Detecting Medial Parapatellar Plicae versus Knee Arthroscopic Findings

Assessment of Diagnostic Accuracy of Knee MRI in Detecting Medial Parapatellar Plicae versus Knee Arthroscopic Findings

Plicae: Where Do They Come from and When Are They Relevant?

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

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