Medial Plica Research Articles

The medial plica syndrome can mimic recurring acute haemarthroses

The medial plica syndrome can mimic recurring acute haemarthroses

Medial plica irritation: diagnosis and treatment

Medial plica irritation of the knee is a very common source of anterior knee pain. Patients can complain of pain over the anteromedial aspect of their knees and describe episodes of crepitation, catching, and pseudo-locking events with activities. Patients commonly have pain on physical examination upon rolling the plica fold of tissue over the anteromedial aspect of their knees and often have tight hamstrings. The majority of the patients will respond well to a non-operative treatment program consisting of quadriceps strengthening along with concurrent hamstring stretching. In cases which do not respond initially to an exercise program, an intraarticular steroid injection may be indicated. In those few patients who do not respond to a non-operative treatment program, an arthroscopic resection of their medial plica may be indicated, especially in those cases where a shelf-like plica has been found to be causing damage to the articular cartilage of the medial femoral condyle.

Relationship of medial plica and medial femoral condyle during flexion

The goal of this study was to investigate the kinematic relationship between medial plica and medial femoral condyle during knee motion. I prospectively selected 30 knees which had different size of medial plica from patients underwent arthroscopic surgery over a one-year-period. I located the inner margins of these plicae by inserting needles percutaneously under direct vision during arthroscopic examination. The topographic changes of the margins of these plicae during knee motion were recorded by fluoroscopy and analyzed. Three types of medial plicae were defined by their size. In all types of the medial plicae, shifting (rubbing, sliding) medially was found when the knee was moved from extension to flexion. They remained in contact with the medial femoral condyles during the whole range of motion. This observation disclosed the kinematic relationship of the medial plica with the medial femoral condyle during knee motion in vivo. This pattern of medial-lateral motion may generate some shearing force acting on the cartilage of the medial femoral condyle. The conclusion of this study may draw more attention to the role of medial plica in the pathogenesis of degeneration of the cartilage on the medial femoral condyle of the knee joint.

Arthroscopic treatment of symptomatic type D medial plica

We aimed to review the results of subtotal arthroscopic resection of symptomatic type D medial plica. We retrospectively evaluated 23 knees with symptomatic type D medial plica in 22 patients without other intra-articular pathology. All patients complained of chronic knee pain that had not been alleviated by medical treatment or physical therapy. In only three (13%) of the patients studied was the plica diagnosed pre-operatively with magnetic resonance imaging. The type D medial plicae in our series were classified as fenestrated (14 knees), torn (5 knees), or reduplicated (4 knees). Fibrotic changes in the plicae and degenerative changes on the medial femoral condyle were found in 16 knees Patellofemoral chondromalacia was present in three knees Arthroscopic partial resection was performed in all patients. Comparative Lysholm Knee Scale scores before and after surgery revealed a significant clinical improvement (pre-operative status, 67.19 +/- 8.05 vs. post-operative status, 90.57 +/- 9.80; P < 0.001). Type D medial plica should be considered as a possible cause of chronic knee pain. Arthroscopic partial resection of the plicae in symptomatic patients gives satisfactory results.

Acute patellofemoral pain: aggravating activities, clinical examination, MRI and ultrasound findings

Objective:To investigate acute anterior knee pain caused by overuse in terms of pain location, aggravating activities, findings on clinical examination and ultrasound/MRI examination. To determine if acute anterior knee pain...

Incidences of Frostbite in Arthroscopic Knee Surgery Postoperative Cryotherapy Rehabilitation

Abstract A retrospective study of 4 cases of frostbite was undertaken to examine causes and to identify related contributory behaviors and circumstances. These patients underwent various surgical interventions before the onset of frostbite during similar postoperative care regimens. Surgical procedures included some of the following in each patient: lateral retinacular release, vastus medialis oblique muscle advancement, partial medial meniscectomy, chondromalacia patella, trochlea, medial and lateral femoral condyle debridement, lateral retinaculum release, and excision of medial plica. The mechanism of onset, development, and sites of frostbite were uniform in all patients. In every case, the sites were located in the area on top of the patella including some adjacent regions depending on the size of each injury. Frostbite locations were correlated with the part of the cryotherapy cold cuff device located on top of the patellar region. This cuff portion was originally designed to accommodate surgical trauma induced during autogenous bone-tendon-bone graft harvest in anterior cruciate ligament reconstruction surgery. Locating cryotherapy over this region assisted in minimizing pain and effusion for patients subsequent to distal patella bone plug harvest trauma. However, the requirement for use of the pad in the patella area for patients not undergoing anterior cruciate ligament reconstruction with autograft was found to be unnecessary and was the primary cause of frostbite in the cases presented here.

Mechanical strength of mediopatellar plica – The influence of its fiber content

The fibrous mediopatellar plica can cause high contact pressure on the adjacent articular cartilage and lead to its degeneration. The purpose of this study was to investigate the biomechanical properties of the plica and to correlate this with the plica's fiber content and patients' ages. An experimental study on the tensile strength of the mediopatellar plica was conducted using high precision micro-force tensile tests. These tests were undertaken on plica specimens taken from 50 knees of patients with different ages. The force-deflection curves resulting from these tests were recorded and transferred to stress-stain curves to obtain the Young's moduli of these specimens. In addition, pathological tissue dyeing tests were used to assess the fiber content ratio of each specimen. The relationship of the Young's moduli of these specimens with the severity of their pathologic change was also evaluated. The Young's modulus of the plica was found to be ranging from 10 to 110 MPa. It has positive correlation with patient's age. The relationship between the fiber content ratio and Young's modulus can be fitted properly using a quadratic regression model. The Young's modulus of the plica was also positively correlated with the severity of its pathologic change. The test results indicated that as patients get older, the fiber content of the mediopatellar plica and the Young's modulus of the plica will increase accordingly. We also demonstrated that the Young's modulus of the medial plica was positively correlated with the severity of the plica lesion.

Patellofemoral Pain Syndrome

To identify the sites and intensity of pain in patients with patellofemoral pain syndrome. A prospective cohort study was conducted at an academic sports medicine practice in Boston, Massachusetts. All patients met inclusion criteria and were enrolled and evaluated during the study time frame. A single sports medicine orthopaedic surgeon examined a consecutive sample of patients with patellofemoral pain not explained by one of several well-defined anterior knee pain diagnoses. The study group consisted of 100 patients (75 females, 25 males) with median age of 14 years. Eleven discrete locations were palpated for tenderness. Hamstring tightness was evaluated by measuring the popliteal angle. Patients reported intensity of pain using a 0- to 9-point ordinal scale. Regression and nonparametric statistical methods were used. The most common site of pain was the patella during anterior-posterior compression (90 patients), followed by the distal pole of the patella, the medial plica, and the nonarticular medial femoral condyle. Median "worst pain" intensity was 6 out of a possible 9. The most common site of "worst pain" was also the patella in compression (63 patients). Median duration of symptoms was 10 months, with an interquartile range of 3 to 20 months. Pain intensity was inversely correlated with duration of symptoms (P < 0.01). In these patients with patellofemoral pain syndrome, the major source of pain was the patella subchondral bone.

Medial Plicae and Degeneration of the Medial Femoral Condyle

The purpose of this study was to evaluate and analyze the chronological changes of the pathologic medial plica and the chondral lesions on the medial femoral condyle. The relationship between the severity of the pathologic medial plica and that of the chondral lesions on the medial femoral condyle was also investigated. Retrospective case series study of consecutive patients who underwent arthroscopic surgery. A retrospective case series study was conducted to review the findings of 1,587 knees of 1,263 patients who had received arthroscopic surgery between 1989 and 2001. The medial plica was classified by its size and the severity of its gross pathologic change. The location and severity of the cartilaginous degeneration on the surface of the medial femoral condyle of these patients were also investigated. The correlation of patient age with the gross pathologic change of their medial plica and the severity of the cartilaginous degeneration on the surface of the medial femoral condyle was analyzed. We found that 472 knees (29.7%) of 378 patients (29.9%) had the structure of the medial plica. The incidence was significantly higher (66.9%) in patients with osteoarthritic knees. The severity of the gross pathologic change of the medial plica was positively correlated with patients' age. The size of the plica was found to be smaller in older patients. Two distinct areas of degenerative cartilaginous lesion related to the medial plica were found on the surface of the medial femoral condyle in 97% of the knees with the structure of the medial plica. The severity of the degeneration was positively correlated with patients' age and the severity of the pathologic change of the medial plica. According to our observation, medial plica was more commonly found in patients with osteoarthritic knees. Cartilaginous degeneration on the surface of the medial femoral condyle could be found in most of the knees with a medial plica. The severity of the degeneration was positively correlated with the severity of the medial plica and patients' age. Level III.

Symptomatic Lateral Patellar Plica: A Case Report

The plica is a remnant of the synovial folds during the coalescence of three compartments of the knee at 8 weeks of fetal development. The plica are classified according to their corresponding anatomic sites of the knee, such as suprapatellar, medial patellar, infrapatellar and lateral patellar plica. The medial patellar plica is considered to be the one most likely to cause problems and has been well documented in the literature. However, there are very few reports of problems being caused by lateral plica. We encountered one case of pathologic lateral plica that was excised by arthroscopy. We report this case with a review of the relevant literature.

Infrapatellar Plica as a Cause of Anterior Knee Pain

This study seeks to show that in the case of a patient not responding to nonoperative measures for the treatment of anterior knee pain, arthroscopic release of a symptomatic infrapatellar plica can successfully resolve the disability. We report a retrospective study of 12 cases of anterior knee pain not responding to nonoperative treatment that underwent isolated infrapatellar plica resection without other noted knee pathology. Patients were evaluated and treated in an outpatient orthopedic sports medicine clinic. Any patient who presented with anterior knee pain, underwent subsequent arthroscopy, and was treated by isolated resection of the infrapatellar plica was included in the study. The surgical procedure involved arthroscopic division of the infrapatellar plica at its attachment on the superior intercondylar notch of the femur. Patients were reviewed at least 12 months following the date of surgery. Two subjective knee scales were used to assess knee function. A subjective scale used in prior studies assessing symptomatic medial plica demonstrated 91% percent (11 of 12) excellent (6) or good (5) outcomes at follow-up greater than 1 year. The Knee Injury and Osteoarthritis Outcome Scores of knee function on the subscales of pain, symptoms, activities of daily living, sports activity, and quality of life were 97, 96, 99, 99, and 87, respectively. These cases demonstrate a potential role for the infrapatellar plica as a cause of anterior knee pain. A prospective study is warranted to measure causality.

Bucket-handle tear of medial plica

Plicae are synovial folds, classified according to their anatomical relationship to the patella. The medial patellar plica is normally asymptomatic, but it may cause symptoms when it becomes thickened and fibrotic. We describe three cases of bucket-handle tear of the medial patellar plica. They all suffered from anterior knee pain and clicking. Our cases' symptoms began when they incurred twisting injuries to the knee; therefore, we think that they had an asymptomatic plica first. Pain and clicking began because of the bucket-handle portion rubbed over the medial femoral condyle with knee flexion, and they improved after resection of the bucket-handle portion. Consequently, we think that medial patellar plica can be symptomatic not only when it becomes thickened or fibrotic but also when a bucket handle tear occurs.

Quadriceps fat pad signal intensity and enlargement on MRI: prevalence and associated findings.

The purpose of this investigation was to characterize the MRI appearance of the quadriceps fat pad and to correlate the findings with other knee abnormalities, anatomic measurements of the extensor mechanism, and findings from history and at physical examination. Ninety-two consecutive knee MRI examinations from 84 patients were retrospectively reviewed by two musculoskeletal radiologists for quadriceps fat pad enlargement and signal intensity. Other data from the retrospective review included infrapatellar and prefemoral fat pad signal intensity, quadriceps and patellar tendon abnormalities, joint effusion, medial plica, chondromalacia, articular muscle thickness, and prepatellar edema. The patellar length, patellar articular length, patellar tendon length, and femoral sulcus angle were measured. MRI reports were reviewed for meniscal and ligament abnormalities. Clinical data were reviewed for findings of anterior knee pain in the history and at physical examination. The chi-square and Student's t tests were used to determine significant associations. Twelve percent (11/92) of MRI examinations showed quadriceps fat pad mass effect on the suprapatellar recess, which was associated with intermediate or fluid signal intensity of the quadriceps fat pad (chi(2) = 7.19, p = 0.0274) but with no other findings on knee MRI. Anterior knee pain at physical examination was associated with quadriceps fat pad mass effect (chi(2) = 8.76, p = 0.0031), medial collateral ligament abnormality (chi(2) = 4.83, p = 0.0031), and history of anterior knee pain (chi (2) = 22.76, p < 0.0001). Enlargement of the quadriceps fat pad on MRI has a prevalence of 12% and is significantly associated with intermediate or fluid signal intensity of the quadriceps fat pad and anterior knee pain.

Magnetic resonance characteristics of medial plica of the knee: correlation with arthroscopic resection.

The purpose of this study was to determine if there are magnetic resonance (MR) characteristics of the medial plica that correlate with the likelihood of plica resection. Sixty-six knee MR examinations from patients who underwent subsequent knee arthroscopy were evaluated retrospectively for the presence of a medial plica. The plicae were then characterized by relative width, thickness, relation to the trochlear cartilage, associated cartilage changes, and effusion. The arthroscopy reports from each knee were reviewed for the presence, description, and resection of medial plicae. A medial plica was demonstrated by MR in 46 of 66 (69.7%) cases. A medial plica was mentioned in 16 of 66 (24.2%) arthroscopic reports. No MR characteristics were significantly predictive of resection. Location of a plica adjacent to cartilage had a P value of 0.0786, plica width had a P value of 0.0858, and plica thickness had a P value of 0.1685. No MR characteristics of medial plicae were found to be predictive of subsequent resection at arthroscopy.

Infrapatellar Plica as a cause of Anterior Knee Pain

1066 Despite the prevalence of anterior knee pain in sports medicine, the etiology of many cases remains unclear with resultant long-term pain and limited function. While the medial plica is a well document source of knee pain, the infrapatellar plica has yet to be implicated as a source of knee pain. When inflamed, fibrotic, or torn, the infrapatellar plica has the potential to cause anterior knee pain. PURPOSE: To determine if isolated resection of the infrapatellar plica in a select group of individuals improves anterior knee pain. METHODS: A restrospective case series analysis involving twelve cases of isolated infrapatellar plica resection in patients with anterior knee pain was performed. Charts were reviewed to assess mechanism of injury, clinical symptoms, and physical exam findings. Telephone interview was used to evaluate each patient. A standardized and validated outcome meansure, The Knee injury and Osteoarthritis Outcome Score (KOOS), was used to assess post-surgical outcome. RESULTS: Ninty-one percent (11 of 12) of patients reported excellent or good results using a subjective knee scale at follow-up. The KOOS outcome scoring of knee function demonstrated average scores of 97, 96, 99, 99, and 87 for pain, symptoms, activities of daily living, sports activity and quality of life, respectively. CONCLUSIONS: Review of these cases demonstrates the potential role of the infrapatellar plica, when abnormal, in causing symptoms consistent with anterior knee pain. Future randomized, prospective studies addressing the role of the infrapatellar plica in causing knee pain are thus warrented.

The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears

Purpose: The purpose of this study was to document the accuracy of joint line tenderness in the diagnosis of meniscal tears. Type of Study: Prospective cohort study. Methods: There were 104 male recruits (age range, 18 to 20 years; mean, 19.2 years) with suspected meniscal lesions who underwent arthroscopy. A thorough history and physical examination was performed on each patient by a physician with 4 years’ experience on arthroscopic knee surgery. Twenty-six (25%) patients sustained injuries while in the Turkish Army, and 78 patients (75%) sustained injuries before they came to the army. On physical examination, assessment of joint line tenderness at the lateral and medial joint lines was performed with the patient’s knee flexed 90°. The accuracy, sensitivity, specificity, and positive and negative predictive values of joint line tenderness for medial and lateral sides were calculated based on arthroscopic findings. Results: In 104 knees, the diagnosis was correct in 71 (68%) and incorrect in 33 (32%) knees. A total of 37 medial meniscal tears and 27 lateral meniscal tears were identified at arthroscopy. Other pathology included 11 anterior cruciate ligament (ACL) tears, 5 medial femoral chondral lesions, 4 chondromalacia patellae, and 1 medial plica. No discernable abnormalities were seen in 21 knees. A preoperative diagnosis of a medial meniscal tear was made in 54 knees and 32 were confirmed at arthroscopy. A lateral meniscus tear was suspected in 27 knees and confirmed in 25. Five medial meniscus and 2 lateral meniscus tears were seen at arthroscopy. These had not been suspected with tenderness over the joint line. The accuracy of the test was lower with the presence of ACL lesions and condromalacia patella. Conclusions: I concluded that joint line tenderness as a test for lateral meniscal tears is accurate (96%), sensitive (89%), and specific (97%). However, for medial meniscal tears, rates are lower.

Intra-articular ganglion cysts of the knee joint: a report of 85 cases and review of the literature.

Intra-articular ganglia and cysts of the knee joint are rare and mostly incidental findings in MRI and arthroscopy. During a period of 15 years, nearly 8000 knees were arthroscopically examined. In total, 85 intra-articular soft tissue masses were found within the knee cavity. Of these, 76 were incidental and asymptomatic findings in arthroscopy performed for treatment of osteoarthritic symptoms. Several repeated minor knee traumata were reported in this group but no histories of serious traumatic events. Nine ganglion cysts were obviously solely responsible for the intermittent or chronic non-specific knee discomfort, and classified as symptomatic. There were no histories of previous injury to the knees, no clinical signs of instabilities or meniscal and femoropatellar pathologies, and no associated further intra-articular lesions in arthroscopy. Forty-nine cystic masses originated from the ACL, 16 from the PCL, 12 from the anterior (eight medial, four lateral) and three from the posterior horn of the menisci (two medial, one lateral). Three were located in the infrapatellar fat pad, one arose from a medial plica and one from a subchondral bone cyst. All ganglion cysts were successfully resected or excised using arthroscopic technique. A review of the literature is given and compared with the findings and data of this study.

KNEE PAIN - WEIGHT LIFTER

HISTORY 35 year old male presented with right anteromedial knee pain that began following his routine weight training workout 8 days prior to presentation. Pain fairly constant. No alleviating factors. Symptoms worsened over past 8 days. He denied any trauma. He denied any previous history of knee pain. He denied swelling, instability, locking, or other mechanical symptoms. He denied constitutional symptoms. No history of crystalline-induced arthropathy. Alcohol intake <2 drinks per week. Denied use of anabolic-androgenic steroids. Works as a customs engineer which requires being on his feet most of the day. No family history of rheumatologic disease. PHYSICAL EXAMINATION Afebrile, Right knee with trace effusion. No erythema or warmth. Full extension; Flexion to 125 degrees; Maximal area of tenderness over the medial femoral condyle. No joint line tenderness. No ligamentous instability. Negative McMurray's. Negative patellar apprehension test. Normal gross neurologic and vascular exam. DIFFERENTIAL DIAGNOSIS Medial meniscal tear. Osteochondral or chondral defect. Avascular necrosis. Femoral stress fracture. Crystalline-induced arthropathy. Medial plica syndrome. Pes anserine bursitis. Saphenous neuritis. Loose body. Quadriceps tendon tear (partial). TEST AND RESULTS AP/LAT, notch and sunrise radiographs — small suprapatellar joint effusion; otherwise normal. - MRI — abnormal increased signal within the distal vastus lateralis; — intrameniscal abnormality within the posterior horns of the medial and lateral menisci, without tear, — small joint effusion - Patient declined arthrocentesis - Positive Tinel's test over the saphenous nerve - Diagnostic local lidocaine injection of the saphenous nerve near its exit from the adductor canal - complete resolution of symptoms. FINAL/WORKING DIAGNOSIS Saphenous neuritis (right medial knee). TREATMENT and OUTCOMES Patient with complete resolution of symptoms upon leaving the office. Failed to keep follow-up appointment. Patient was called 1 and 3 months after presentation and has been completely pain free. No nerologic complaints. Returned to all previous activities (work and weight lifting) without problems.

Medial synovial plica syndrome of the knee: a diagnostic pitfall in adolescent athletes.

Medial plica syndrome is usually a rare cause of anterior knee pain, but in adolescent athletes it is more common. A prospective investigation of clinical criteria for the diagnosis of medial plica syndrome was carried out. Investigating the stress test for the diagnosis of medial plica syndrome, we used active extension as a kick test and flexion to test blocking of swinging of the shank. The aim of this investigation was to examine these two new tests. The tests we used improved the accuracy of the clinical examination and allowed diagnosis of the symptomatic medial plica.

Medial synovial plica syndrome of the knee: a diagnostic pitfall in adolescent athletes

Medial plica syndrome is usually a rare cause of anterior knee pain, but in adolescent athletes it is more common. A prospective investigation of clinical criteria for the diagnosis of medial plica syndrome was carried out. Investigating the stress test for the diagnosis of medial plica syndrome, we used active extension as a kick test and flexion to test blocking of swinging of the shank. The aim of this investigation was to examine these two new tests. The tests we used improved the accuracy of the clinical examination and allowed diagnosis of the symptomatic medial plica.