How Does Delayed Excision of Symptomatic Medial Plica Affect the Outcomes?

Abstract

Objectives:Medial plica (MP) is usually asymptomatic, however has the potential to cause impingement on the medial femoral condyle when it is prominent or thickened. The incidence of MP has been reported up to 79.9%. Very few of them become symptomatic over time. Due to delay in seeking medical assistance or extended conservative treatment, surgery may be delayed in some of the patients and this might cause increased chondral damage. The purpose of this study is to compare the outcomes of patients who received early surgery with patients undergoing delayed surgery one year after the onset of symptoms.Methods:Sixteen knees of the 14 patients (7 male, 7 female), who underwent arthroscopic MP excision between 2007 and 2011 were included in this retrospective study. In six patients had right, six patients had left and in two patients had both knees involved. Plicas, which were seen in patients with ligament injury were excluded from the study. Mean age was 42.9 years (range; 23-62). All patients complained of pain but some had mechanical symptoms such as friction during flexion-extension. Patients were evaluated with visual analogue scale (VAS) and Lysholm scores pre-operatively and at the last examination. The knees which were operated on within the first year (range; 1-12 months) after being symptomatic were grouped as Group 1 and the ones operated on after that time (range; 18-180 months) Group 2. More advanced chondral lesions were in the second group. Two groups were compared statistically by using “paired t test” in terms of VAS and Lysholm scores at the last control examination.Results:All patients had cartilaginous degeneration of various degrees on the surface medial femoral condyle facing the MP. Pre-operative (5.62±1.66) and final follow-up mean VAS (2.31±2.02) scores and mean Lysholm scores (65.62±13.82 and 83.43±15.51, respectively) were significantly different (p<0.005). Mean VAS score was 2.00 (±2.39) in Group 1 and 2.62 (±1.68) in Group 2 at final evaluation. Mean Lysholm scores were 81.25 (±20.04) and 85.62 (±10.16) respectively for Groups 1 and 2. Both of these differences were not statistically significant(p>0.05).Conclusion:All patients obtained satisfactory outcomes after arthroscopic MP excision. MP is usually asymptomatic but, when it is large and its free edge impinges on the superior anteromedial and medial portion of the medial femoral condyle, it might cause chondral damage leading to full thickness cartilage lesions. When it becomes symptomatic, chondral damage quite often is already advanced. This small series revealed that, even late arthroscopic excision of the MP relieves symptoms but, chondral damage persists even though the patient becomes asymptomatic. The reasons of this might be; 1) the region of lesion is outside of weight bearing zone or 2) the origin of pain might be stretched MP before excision.