Mediopatellar Plica Research Articles

Correlation between Plica Mediopatellar Damages and Cartilage Lesions on Arthroscopic Findings of The Knee

Introduction: The mediopatellar plica are folds in the synovium that represent the embryological remnant in the development of the synovial cavity of the knee. Our study aim to investigate the damage to the mediopatellar plica using the Sakakibara classification and cartilage lesions using the Outerbridge classification based on the arthroscopy findings of the knee. Methods: A multi-center retrospective cross-sectional analytical study was conducted on patients at Wahidin Sudirohusodo Hospital and network teaching hospitals in Makassar, South Sulawesi Indonesia, the study was conducted in January – March 2021. The results of assessment the damage to mediopatellar plica using the Sakakibara classification and Cartilage lesions use the outer bridge classification. After that, data was processed to analyze the correlation between damage to the mediopatellar plica and cartilage lesions as well as related variables. Results: In the early study, 119 patients were included, where the final follow-up was obtained for 91 patients (76.5%). The existence of a positive correlation between damage to the mediopatellar plica based on the Sakakibara Classification and cartilage lesions based on the Outerbridge Classification, where the greater the damage to the mediopatellar plica based on the Sakakibara Classification, the higher the cartilage lesions based on the Outerbridge Classification. Conclusions: There is a relationship between the characteristics of the sample and plica damage based on the Sakakibara classification, meanwhile, the plica damage based on the Sakakibara classification shows the opposite result. There is a corelation between plica damage based on the Sakakibara classification and Cartilage lesions based on the Outerbridge classification.

Accuracy And Difficulty of Preoperative Diagnosis for Mediopatellar Plica Syndrome

Background: There is no consensus on the optimal method for the definitive diagnosis of mediopatellar plica syndrome. Currently, the diagnosis is made based on the patient history and is supported by physical examination. In this study, we retrospectively examined the accuracy of pre-arthroscopic diagnosis. Result: Five knees (20%) were diagnosed with mediopatellar plica syndrome based on MRI before arthroscopic examination. The pre- arthroscopic diagnosis rate of mediopatellar plica syndrome was 18 knees (72%). Complete suprapatellar plica and mediopatellar plica were noted in 3 knees. Mediopatellar plica (type C) and patellofemoral disorder were observed bilaterally in one patient. Conclusion: Our results imply that collecting a more detailed patient history and conducting a thorough physical examination are both important in definitive diagnosis of mediopatellar plica syndrome. However, it should be noted that mediopatellar plica syndrome may accompany patellofemoral disorders.

Validation and cultural adaptation of Russian version of KOOS-Child questionnaire

Introduction. In our research 100 patients (51 male and 49 female) aged below 18 were assessed with the following knee problems: meniscal, anterior cruciate ligament, posterior cruciate ligament tears, mediopatellar plica syndrome, osteochondritis dissecans.
 Aim: validation and cultural adaptation English version of KOOS-Child questionnaire for Russian language children and adolescent patients. Also, for using in N.N. Priorov National Medical Research Center of Traumatology and Orthopedics and other medical hospitals of Russian Federation.
 Materials and methods. KOOS-Child has been translated in Russian language by orthopedist who is advanced in English and by professional medical translator. For control group we used Lysholm knee score. After all procedures statistical analysis was used. It consists of 3 stages: general data analysis, validation checking of questionnaire, checking objectivity and relevance of results.
 Conclusions. Cronbachs alpha test score shows up very high-level consistency of the questions (0,959). Questions have high discriminatory power and results of assessment are objective and adequate. Methods of statistical analysis showed up that questionnaire can be use in practice by orthopedist.

Clinical Management of Medial Patellar Plica Syndrome: Mini Review from Diagnosis to Treatment.

Synovial plicae are thickenings of the synovial knee membrane; they are very frequent and often asymptomatic. However, they can become symptomatic due to idiopathic or secondary causes, like trauma and inflammation of the synovial tissue. Currently, synovial plicae are classified as infrapatellar, mediopatellar and suprapatellar. The prevalence of the mediopatellar plica over the other forms of plicae varies between 18% and 60%. The most reported symptom of the mediopatellar plica is pain located medial to the patella above the joint line. Magnetic Resonance Imaging (MRI) is the most useful examination to highlight the presence of the plica, its measurement and exact location. The treatment is initially conservative, i.e. medical treatment and physiotherapy, however when these fail, the plica should be removed surgically via arthroscopy. In the current paper, we aim to report our clinical experience in the management of medial patellar plica syndrome by describing the clinical presentation and diagnosis of this condition as well as its treatment.

Clinical relevance of mediopatellar plica of the femoropatellar knee joint (literature review)

The problem of diagnosis and treatment of the mediopatellar plica (MP) syndrome is urgent, since the pathology of this formation has not been studied sufficiently in adults, children and adolescents. MP syndrome causes pain in the anterior knee joint in 3.25–11 % of cases. The average frequency in adult population varies from 20 to 60 %. At arthroscopy intervention, the MP was detected in 14–100 % of patients, and 25–34 % of cases were found during autopsy of the dead bodies. At normal conditions the MP is thin, corneal and flexible. In the case of an in­flammatory process in the joint, it becomes swollen, thickened and affects the movement in the patella-femoral joint, determining changes in the cartilage of the knee and medial surface of the femur. In pathological MP, usually increases vascularization, it is noted hyalinization and signs of inflammation. Chronic cases of MP syndrome are characterized by fibro-cartilage metaplasia, progression of collagenosis and calcification. The most common is the classification by J. Sakakibara based on the size of the MP. Type A and B plicae are not always accompanied by symptoms; types C and D can be sandwiched between the medial growth and the knee and become thickened causing internal damage to the knee joint. The complexity of the diagnosis is due to the fact that clinical manifestations often mimic the symptoms of damage of the meniscus and ligaments. Pathology of MP is not different from the clinic of other knee injuries, except for the clear localization of pain, which is abruptly exacerbated during bending of the knee joint in the range from 150° to 110° and accompanied by a feeling of clicking. The most informative non-invasive methods of diagnosis of MP syndrome are ultrasound and MRI. For the treatment conservative and surgical methods are used. There are a small number of papers in which the authors describe the relationship between patello-femoral joint dysplasia and the presence of MP. In our opinion, the study of this issue is noteworthy. This will help to understand the causes of the syndrome, diagnosis and treatment tactics.

Mediopatellar plica syndrome of the knee

Mediopatellar plica syndrome of the knee

Magnetic resonance assessment of medial plica syndrome of knee from child to adult with arthroscopic correlation: A single center experience and literature review.

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.

Superolateral Hoffa's Fat Pad Edema and Trochlear Sulcal Angle Are Associated With Isolated Medial Patellofemoral Compartment Osteoarthritis

PurposeTo evaluate whether mediopatellar plica and knee morphometric measurements obtained from magnetic resonance imaging (MRI) studies are associated with isolated medial patellofemoral osteoarthritis in young adults. MethodsMRI studies from 60 patients with isolated medial patellofemoral osteoarthritis and 90 control patients with normal knee MRI studies were reviewed. The presence of mediopatellar plica, the presence of edema in the superolateral aspect of Hoffa's fat pad and suprapatellar fat pad, quadriceps and patellar tendinosis, and axial and sagittal alignment of the patellar and trochlear morphology were assessed using MRI. The relationship between mediopatellar plica, alignment, or morphology and the presence of isolated medial patellofemoral osteoarthritis was evaluated using logistic regression. ResultsSuperolateral Hoffa's fat pad edema (odds ratio [OR] = 3.4, P = .009) and decreased trochlear sulcal angle (OR = 0.95, P = .045) were associated with increased odds of isolated medial patellofemoral osteoarthritis. Decreased lateral patellar tilt (OR = 0.93, P = .087) and patellar tendinosis (OR = 4.13, P = .103) trended toward being associated with increased odds of isolated medial patellofemoral osteoarthritis but were not statistically significant. No significant association was seen between the presence of mediopatellar plica and medial patellofemoral osteoarthritis (OR = 0.95, P = .353). ConclusionsMedial patellofemoral osteoarthritis is associated with trochlear morphology and patellar alignment but not with mediopatellar plica.

Evidence for plical support of the patella.

There is a consensus that there is no overt anterior joint capsule in the knee. However, other anterior structures act in lieu of a joint capsule: the quadriceps tendon and patellar retinacular fibres. In the absence of a capsule, the synovium forms the suprapatellar pouch. Other synovial structures, the plicae, are more controversial. They are often described as embryonic remnants with no function, despite surrounding the patella. We aimed to identify plical anatomy and histology on cadaveric dissection and to examine their embryology using the human virtual embryo website. Plicae were identified by two independent observers. Plical histology was examined using a panel of stains: H&E, Ab H&E, EVG and MSB trichrome. Embryonic knees were examined from Carnegie stages 20-23. Each knee had a suprapatellar plica and mediopatellar plica (MPP). The lateropatellar plica (LPP) appeared as a band in 5/10 cadavers, and as a ridge in the remainder. The overall impression, consistent across all specimens, was that the plicae formed a continuous band of synovial tissue around the proximal three-quarters of the patella. The infrapatellar fat pad (IFP) surrounded the remainder. Histologically, the plicae and IFP consisted of three layers (in order): a synovial layer, an undulated collagenous layer, and an adipose or areoloadipose layer. The subsynovial collagenisation is normally associated with the synovio-capsular boundary. Embryologically, plicae were not seen in either knee at any level for any given Carnegie stage. We suggest that plicae, along with the dynamic IFP, provide internal support to the patella mirroring the external support of retinacular fibres. Thus, the plicae complete the tissue complex acting in lieu of an anterior joint capsule. Evidence of plical functionality lends credence to the theory that the plicae are anatomical structures not functionless embryonic remnants.

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

Anterior knee pain is a frequent, yet relevant, symptom since mediopatellar plicae are found in approximately 20% of normal knees. We report the rare case of a painful mediopatellar plica and cord-like structure complex covering the suprapatellar pouch in the knee joint. The patient was a 13-year-old girl who complained of left anterior knee pain with restricted range of motion that had started 1 year earlier. She underwent arthroscopic treatment after unsuccessful conservative therapy. Intraoperative findings included a Sakakibara classification Type B mediopatellar plica and band-like structure complex located in the suprapatellar pouch of the knee. As Type A and B plicae are generally asymptomatic, the cause of the pain in this case was presumed to be impingement of the mediopatellar plica by the cord-like band. The plica and band-like structure complex was resected and ablated by arthroscopy. The patient was pain-free several months postoperatively and could resume normal school life. Since she was an adolescent in her growth phase, it is possible that joint growth 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.

Substance-P in symptomatic mediopatellar plica as a predictor of patellofemoral pain.

The present study aimed to investigate the expression of a neuropeptide of symptomatic mediopatellar plica (MP) to prove that there was a significant correlation between the expression of substance-P (SP) in MP and patellofemoral pain. The specimens of synovial plica were obtained by knee arthroscopy. Semi-quantitative analysis was used to investigate the expression of SP, and compared the innervation density of SP among the three groups: Blank control (asymptomatic plica), positive control (symptomatic plica with other injuries) and experimental (symptomatic plica without other injuries) groups by the paired t-test, one-way analysis of variance and Student-Newman-Keuls test in 60 patients. The expression levels of SP nerve fibers in the superior plica were 24.60±26.17, 117.36±73.62 and 59.06±44.06 in the blank control, positive control and experimental groups, respectively. The density of nerve fibers in medial plica was 23.23±18.41 in the blank control group, 268.00±71.60 in the positive control group and 255.44±87.91 in the experimental group. The density of nerve fibers of MP was higher compared to that of the superior plica. The density was highest in the positive control group, and lowest in the blank control group in MP. There was a close correlation between the density of SP expression and the degree of patellofemoral pain. The SP expression intensity has an important role in the incidence of patellofemoral pain and is responsible for the pathogenesis of symptomatic MP.

Mediopatellar plica as a risk factor for knee osteoarthritis?

Mediopatellar plica as a risk factor for knee osteoarthritis?

Medial Femoral Condyle Degeneration Associated with a Mediopatellar Plica

Medial Femoral Condyle Degeneration Associated with a Mediopatellar Plica

MRI of anterior knee pain

Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa's disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.

Prevalence of MRI-detected mediopatellar plica in subjects with knee pain and the association with MRI-detected patellofemoral cartilage damage and bone marrow lesions: data from the Joints On Glucosamine study

BackgroundThe mediopatellar plica is a synovial fold representing an embryonic remnant from the developmental process of the synovial cavity formation in the knee. We aimed to examine the frequency of MRI-detected mediopatellar plica and its cross-sectional association with MRI-detected cartilage damage and bone marrow lesions (BMLs) in the patellofemoral joint (PFJ) in a cohort of subjects with knee pain.Methods342 knees with chronic frequent knee pain were evaluated for MRI-detected mediopatellar plica (type A, B or C according to the modified Sakakibara classification). Cartilage damage (scored 0 to 6) and BMLs (scored 0 to 3) were semiquantitatively assessed in four subregions of the PFJ on MRI. Hoffa-synovitis and effusion-synovitis were graded 0 to 3. Patellar length ratio (PLR), lateral patellar tilt angle (LPTA), bisect offset (BO), and sulcus angle (SA) were measured on MRI. The presence of mediopatellar plica and its association with cartilage damage and BMLs in the PFJ was assessed using logistic regression after adjusting for age, gender, body mass index, PLR, LPTA, BO, SA, and Hoffa- and effusion-synovitis.Results163 (47.7%) knees exhibited mediopatellar plica (76 (22.2%) type A, 69 (20.2%) type B, and 18 (5.3%) type C) on MRI. Significant cross-sectional associations of MRI-detected mediopatellar plica and cartilage damage were observed for the medial patella (adjusted odds ratio (aOR) 2.12, 95% CI 1.23-3.64 for all types combined, and aOR 4.20, 95% CI 1.92-9.19 for type B lesion), but not for the anterior medial femur or the lateral PFJ. No associations were found between the presence of MRI-detected mediopatellar plica and BMLs in any patellofemoral subregion.ConclusionOn MRI, types A and B mediopatellar plicae were commonly observed in this cohort of subjects with knee pain. MRI-detected mediopatellar plica was cross-sectionally associated with higher likelihood of the presence of MRI-detected medial patellar cartilage damage after adjustment for confounders.

Calcific mediopatellar plica: a case report

A 38-year-old male patient was admitted to our clinic with the complaints of pain and swelling in his right knee for two years. He had mechanical symptoms for nearly six months. Merchant and lateral knee X-ray revealed calcification in the medial patellar retinaculum. Magnetic resonance imaging demonstrated increased ossification and cortical irregularity in the patella's medial and inferior pole. Due to long-term complaints of the patient, arthroscopy was planned with the preliminary diagnoses of patellofemoral chondromalacia, cartilage degeneration and mediopatellar plica (MPP) syndrome. Arthroscopy revealed a calcific MPP, an interesting entity. It should be kept in mind that plica may become calcific in patients with suspected MPP and the complaints of the patient may not disappear within if left untreated.

Assessment of perfusion in osteoarthritis induced bone marrow lesions using dynamic contrast enhanced magnetic resonance imaging

Assessment of perfusion in osteoarthritis induced bone marrow lesions using dynamic contrast enhanced magnetic resonance imaging

Cartilage loss, measured with mri, predicts knee replacement - data from the osteoarthritis initiative

Cartilage loss, measured with mri, predicts knee replacement - data from the osteoarthritis initiative

Prevalence of mediopatellar plica in subjects with knee pain and the association with patellofemoral cartilage damage and bone marrow lesions: the jog study

Prevalence of mediopatellar plica in subjects with knee pain and the association with patellofemoral cartilage damage and bone marrow lesions: the jog study

Review Article: Plica Syndrome of the Knee

Plica syndrome is a pathological condition secondary to inflammation. Plicae around the knee are common and generally asymptomatic. They often are misdiagnosed. The morphology of knee plicae varies; mediopatellar plicae are the most common cause of the plicae syndrome. An intermittent dull pain is the most common symptom. Diagnosis is made by exclusion. Ultrasonography is useful; arthroscopy is the gold standard. Arthroscopic removal of the plica may be necessary when conservative treatment for up to 6 months fails.