Retinacular band excision improves outcome in treatment of plica syndrome

Abstract

Mild symptoms usually continue after excision of the medial patellar plica. We noticed that the palpable tender cord, located on the anteromedial aspect of the knee in patients with plica syndrome, did not disappear completely after excision of the synovial fold. Beneath all plicae, a retinacular band was visible, and only after excisions of this band did the cord become impalpable. We conducted a study to determine the role of these medial retinacular bands in the symptomatology of the disorder. Twenty-four knees of 22 patients diagnosed with medial patellar plica syndrome were divided into two groups. In the first group, arthroscopic excision of the synovial plica was performed. In the second group, retinacular bands beneath the plica were additionally excised. When Lysholm scores were compared, we found that the second group showed significantly greater improvement. We believe that the retinacular bands play a role in the symptomatology and the pathophysiology of plica syndrome and that excision improves the outcome.Résumé Habituellement des symptômes discrets persistent après excision du plica médiopatellaire. Nous avons constaté que le cordon palpable présent dans la partie antéromédiale du genou chez les malades avec un syndrome de plica n'a pas complètement disparu après excision du repli synovial. Sous tous les plicas une bande retinaculaire était visible et seulement après excision de cette bande le cordon est devenu impalpable. Nous avons conduit une étude pour déterminer le rôle de ces bandes rétinaculaire médiales dans la symptomatologie persistante. Vingt-quatre genoux de 22 malades présentant un syndrome du plica médio patellaire ont été divisés en 2 groupes. L'excision arthroscopique du plica synovial était faite dans le premier groupe et dans le deuxième groupe la bande rétinaculaire sous le plica a été excisée en plus. Quand les scores de Lysholm ont été comparés nous avons vu que le deuxième groupe avait une meilleure améliora-tion, statistiquement significative. Nous croyons que cette bande rétinaculaire joue un rôle dans la symptomatologie et la physiopathologie du syndrome du plica et que son excision améliore le résultat.

Characteristics of medial plica syndrome complicated with cartilage damage

“…Patients resistant or unresponsive to conservative treatment may be treated surgically. Excellent results have been reported after the excision of symptomatic medial plicae [3,14,[16][17][18][19][20]. However, depending on the shape of the medial synovial plica and the duration of the impingement, cartilage damage may have already occurred or there may be concern about its future occurrence.…”

Medial Abrasion Syndrome

“… 37 The main rationale for this AMR was to eradicate the friction or impingement between the pathologic medial plica and the adjacent medial femoral condyle 32 – 34 by resecting the plica and releasing the fibrotic medial joint capsule and retinaculum. The beneficial effect of releasing retinaculum bands has also been verified and reported by Yilmaz et al 52 The effect of AMR was validated by a recent study 35 that investigated interleukin-1β (IL-1β) mRNA and matrix metalloproteinase-3 (MMP-3) mRNA expressions in the medial plica isolated from patients with different stages of medial compartment OA of the knee. According to this study, the repeated abrasions of the medial plica triggered IL-1β production and enhanced the expression of MMP-3.…”

A Rare Painful Mediopatellar Plica and Cord-Like Structure Complex in the Knee Joint

“…Pekmezci et al described the case of a pathologic plica involving a check-valve mechanism [10]. Yilmaz et al reported that retinacular bands located beneath plicae on the anteromedial aspect of the knee in patients with plica syndrome played a role in the symptomatology and pathophysiology of plica syndrome and that their excision improved outcome [11]. In this case, similar band-like structures that resembled retinacular bands might have caused the anterior knee pain, as Yilmaz et al have remarked [11].…”

“…Yilmaz et al reported that retinacular bands located beneath plicae on the anteromedial aspect of the knee in patients with plica syndrome played a role in the symptomatology and pathophysiology of plica syndrome and that their excision improved outcome [11]. In this case, similar band-like structures that resembled retinacular bands might have caused the anterior knee pain, as Yilmaz et al have remarked [11]. Since the patient was presumably in her adolescent growth phase, joint growth may have resulted in tension on the remnant of the plica connected with the band-like structure in the suprapatellar pouch, which then intruded into the medial aspect of the patellofemoral joint and resulted in her symptoms.…”