Abstract:To assess the clinical outcomes of a group of patients who underwent arthroscopic infrapatellar plica (IPP) excision and to determine, whether the IPP was symptomatic or not, to identify the symptoms or signs in the patient's clinical presentation and to study the correlations between arthroscopic findings and patient's clinical presentation. A retrospective clinical study. We studied all the patients undergoing arthroscopic resection of symptomatic infrapatellar plica without other intraarticular abnormality … Show more
“…The origin of physiological noise varies and includes a buildup or bursting of tiny bubbles in the synovial fluid, snapping of ligaments, catching of the synovium or physiological plica, hypermobile meniscus or discoid meniscus, and perception of previous noise after knee surgery due to emotional concerns ( Table 1 ). 10 13 15 23 24 25 26 27) …”
Section: Causes Of Physiological Noisementioning
confidence: 99%
“…Other factors can also create physiological noise. Demirag et al 25) reported that the physiological popping or snapping was present in 72% of patients with infrapatellar plica. A young child under 10 years of age with a hypermobile or discoid meniscus has intermittent experiences of popping and snapping without obvious pain.…”
Section: Causes Of Physiological Noisementioning
confidence: 99%
“… 47) The pathological plica can be excised by arthroscopy if it makes refractory and persistent pain in spite of nonsurgical treatment. 25) Many surgical procedures for the patellar instability have been introduced, but the surgical method should be reserved until conservative treatment has failed and the chronic recurrent nature of the disease has caused significant functional improvement. Surgical procedure may address either bony or soft tissue components, in a proximal or distal procedure; lateral release, medial repair, medial patellofemoral ligament reconstruction, tibial tubercle realignment, trochleoplasty can be performed.…”
Section: Management Of Noise Around the Kneementioning
Noise in the knee joint is a common symptom that often leads to outpatient clinic visits. However, there have been no previous review articles regarding noise around the knee despite its high prevalence. We will review the noise characteristics according to sound nature and onset as well as factors for differentiation between physiological and pathological noises. In addition, we will describe causes of the physiological and pathological noises and management of noise in the knee. An appropriate review of the characteristics of noise, its pathophysiology, and factors for differentiation between physiological and pathological noises can facilitate patient guidance. It is important to differentiate between physiological noise and pathologic noise. In most cases, noise after surgery is simply the perception of noise that had been present previously due to emotional concerns. Minor problems associated with surgery, such as postoperative noise, can decrease patient satisfaction, especially among patients with high expectations. Following surgical principles and providing accurate information about physiological noise can decrease the risk of both pathological noise and patient dissatisfaction. In total knee arthroplasty, every attempt should be made to avoid patellar crepitus and clunk by using modern prostheses with proper patellofemoral conformity and by avoiding surgical errors.
“…The origin of physiological noise varies and includes a buildup or bursting of tiny bubbles in the synovial fluid, snapping of ligaments, catching of the synovium or physiological plica, hypermobile meniscus or discoid meniscus, and perception of previous noise after knee surgery due to emotional concerns ( Table 1 ). 10 13 15 23 24 25 26 27) …”
Section: Causes Of Physiological Noisementioning
confidence: 99%
“…Other factors can also create physiological noise. Demirag et al 25) reported that the physiological popping or snapping was present in 72% of patients with infrapatellar plica. A young child under 10 years of age with a hypermobile or discoid meniscus has intermittent experiences of popping and snapping without obvious pain.…”
Section: Causes Of Physiological Noisementioning
confidence: 99%
“… 47) The pathological plica can be excised by arthroscopy if it makes refractory and persistent pain in spite of nonsurgical treatment. 25) Many surgical procedures for the patellar instability have been introduced, but the surgical method should be reserved until conservative treatment has failed and the chronic recurrent nature of the disease has caused significant functional improvement. Surgical procedure may address either bony or soft tissue components, in a proximal or distal procedure; lateral release, medial repair, medial patellofemoral ligament reconstruction, tibial tubercle realignment, trochleoplasty can be performed.…”
Section: Management Of Noise Around the Kneementioning
Noise in the knee joint is a common symptom that often leads to outpatient clinic visits. However, there have been no previous review articles regarding noise around the knee despite its high prevalence. We will review the noise characteristics according to sound nature and onset as well as factors for differentiation between physiological and pathological noises. In addition, we will describe causes of the physiological and pathological noises and management of noise in the knee. An appropriate review of the characteristics of noise, its pathophysiology, and factors for differentiation between physiological and pathological noises can facilitate patient guidance. It is important to differentiate between physiological noise and pathologic noise. In most cases, noise after surgery is simply the perception of noise that had been present previously due to emotional concerns. Minor problems associated with surgery, such as postoperative noise, can decrease patient satisfaction, especially among patients with high expectations. Following surgical principles and providing accurate information about physiological noise can decrease the risk of both pathological noise and patient dissatisfaction. In total knee arthroplasty, every attempt should be made to avoid patellar crepitus and clunk by using modern prostheses with proper patellofemoral conformity and by avoiding surgical errors.
“…The prevalence of synovial plicae ranges from 3% to 30% in western populations with most studies citing approximately 10% [ 1 ]. The inferior and superior plicae are the most common (50%–65%) with very little clinical relevance [ 2 ]. Mediopatellar plica is commonly symptomatic and is present at autopsies in one of the every three or four knees.…”
Objective:
Synovial plicae are mesenchymal tissue remnants invaginating into the knee joint. Their classification is based on the location as lateral, mediopatellar, suprapatellar, and infrapatellar. Mediopatellar plica is commonly symptomatic. The purpose of this study was to identify magnetic resonance (MR) characteristics of the medial plica and to correlate with arthroscopy for cause confirmation in patients with painful knee.
Materials and Methods:
The current study was undertaken over a 2-year period between July 2017 and June 2019 in the department of radiology at a tertiary care hospital in India. MR examinations of the knee joint were performed using QUADKNEE coil on a 1.5-T scanner (Signa, General Electric Medical Systems, Milwaukee, WI, USA). The criteria studied were: presence of the plica, interposition into the femoropatellar joint, intraarticular effusion, and fenestrated aspect. Twenty-two knees (20 patients) diagnosed with mediopatellar plica syndrome on MR imaging (MRI), and with no other knee pathology, were treated with arthroscopic division of plicae.
Results:
Only two (20.0%) of the ten knees in which the plicae had not been divided have shown improvement and six (85.7%) of the seven knees in which plica had been divided (
P
< 0.05) have shown improvement. Subsequent division of the plicae resulted in improvement in seven of the eight knees (87.5%) (
P
< 0.01). Patients presented with crepitus in 9% of cases (2 of 22), instability in 13.6% (3 of 22), pseudo-locking in 45.4% (10 of 22), and quadriceps atrophy in 54.5% (12 of 22). Fourteen knees (63.6%) had Grade 2 plica based on thickness. Twelve knees demonstrated (54.5%) Grade 2 intermediary effusion. Plica was fenestrated in three patients (13.6%). All patients regained full range of motion. Lysholm knee scale scores were compared prior to and postsurgery (preoperative status, 65.22 ± 7.41 vs. postoperative status, 89.43 ± 8.72) which revealed a significant clinical improvement (
P
< 0.001). Average visual analog scale (VAS) scores (0 – no pain, 10 – excruciating pain) when compared demonstrated a mean improvement was 4 points; from 6 points before surgery and 2 points' postsurgery after a mean follow-up of 3 months. About 68% of patients after arthroscopic resection had an average VAS score of 0 point and were totally pain free.
Conclusion:
Noninvasive capability of MRI can be used as a screening method in the diagnosis of mediopatellar plica syndrome and should be included in the differential diagnosis of internal derangement of the knee.
“…This clinical experience, spanning 28 years and hundreds of patients from 9-year-old children to elderly patients, is consistent with several reports in the literature of small numbers of patients in whom AKP has been relieved by release of the IPP at its FA. 23 , 31 , 32 , 33 Fig 1 Non-isometric mechanical behavior of infrapatellar plica (IPP), viewed arthroscopically (screenshots from Video 1 ). Arthroscopic views of the notch from the anterolateral portal (A-E) and anteromedial portal (F) are shown in the right knee of a 16-year-old patient with anterior knee pain for 4 years, with an insidious onset, undergoing release and resection of the IPP at its femoral attachment (FA).…”
Anterior knee pain (AKP), a multifactorial symptom complex, can be successfully treated surgically. A specific diagnosis often cannot be made, but the pain is linked to an unrecognized common factor in most patients: the mechanical behavior of the non-isometric contents of the anterior compartment of the knee—the fat pad (FP) and infrapatellar plica (IPP). The objective of this presentation is to describe an effective arthroscopic technique that treats AKP by addressing this common factor. The operation consists of release or resection of the IPP, or ligamentum mucosum, which tethers the FP. These highly innervated tissues act together as a hydraulic shock absorber, filling the anterior compartment. They stretch and deform at the extremes of knee motion because of constraint centrally by the non-isometric IPP. These dynamic changes in shape are eliminated when the plica is released or resected. Pain perception is from perturbed nociceptive nerves: pain relief results from de-tensioning these contained nerves by untethering the fat pad. Ascribing pain causation is problematic because morphologic change, such as inflammation, fibrosis, or contracture of these structures, is only present in a minority of cases. Nonetheless, AKP is both physically linked to these central, pain-sensitive structures and relieved by this operation.
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