The effects of medial synovial plica excision with and without lateral retinacular release on adolescents with anterior knee pain

Abstract

ObjectivesTo describe the functional outcomes in patients aged ≤18 years with anterior knee pain treated with medial plica excision with or without lateral release.MethodsWe identified 135 patients including 30 bilateral cases (165 knees) with a mean ± SD age of 15.1 ± 2.0 years. Patient and surgical information was recorded and a follow-up athletic questionnaire and an International Knee Documentation Committee (IKDC) Subjective Knee Evaluation form were sent out. Statistical analysis evaluated predictors of residual pain, reoperation, return to sports, IKDC score and satisfaction with surgery.ResultsAt a final mean follow-up of 4.4 years (range 2–7.5), 36 % of patients were pain free, 46 % had mild residual pain and 18 % had pain not improved from surgery. Reoperation was more likely following isolated plica excision (7/41; 17 %) versus plica excision with lateral release (8/124; 6 %), although not statistically significant, P = 0.06. Mean IKDC score (107 knees) was 76.9 ± 17.8 (range 31–100). Most patients (86/99; 87 %) were satisfied with surgery and were able to return to sports (104/120; 87 %).ConclusionsWhile most patients were satisfied and able to return to sports following plica excision with or without lateral release, residual symptoms were common.

Plica Syndrome of the Knee

“…examined 135 patients at a mean of 4.4 years after arthroscopic plica resection with/without lateral release and found that only 36% of patients were pain-free. 30 Because of the guarded long-term prognosis of surgical treatment, exhaustive conservative management is critical in the treatment of this condition.…”

“…A common, yet not well understood, cause of anterior knee pain is synovial plica syndrome. 3,4 For the clinician treating pediatric and adolescent patients with knee pain, an understanding of the pertinent anatomy, presentation, physical exam, and imaging is essential so treatment decisions can be made.…”