Synovial Plica Research Articles

Anatomical variants of the medial synovial fold of the posterior cruciate ligament: morphological classification based on magnetic resonance imaging of the knee.

The medial synovial fold of the posterior cruciate ligament is one of the synovial plicae of the knee joint. The objective of this study was to assess the necessity of reporting the appearance of the medial synovial fold of the posterior cruciate ligament on magnetic resonance imaging of the knee joint and its correlation with side and sex. Patients with normal knee structure on magnetic resonance imaging (MRI) scans between 2018 and 2023 were included in this retrospective study. MRI scans of the knee joints were retrospectively reviewed by two musculoskeletal radiologists independently. The medial synovial fold of the posterior cruciate ligament was divided into three types according to the imaginary line drawn between the lateral border of the medial femoral condyle and the medial tibial intercondylar tubercle. The study included 1147 patients, of whom 478 (41.7%) were female and 669 (58.3%) were male. Among these patients, 580 (50.6%) had a right knee scan, and 567 (49.4%) had a left knee scan. The age range was 15-35 years for both sexes. The frequency of the medial synovial fold types in all patients was as follows: Type A (30.1%), Type B (55.4%) and Type C (14.5%). There was a high level of agreement between the observers. There was a statistically significant difference in the frequency of medial synovial fold types between sexes, with men exhibiting a greater prevalence. Magnetic resonance imaging (MRI) of the knee joint revealed the medial synovial folds of the posterior cruciate ligament (PCL). The most common was Type B (55.4%), followed by Type A (30.1%) and Type C (14.5%) among the MSF types. No statistically significant difference was found between the right and left knees for any of the MSF types.

Morphometric and Histological Analysis of the Ligamentum Mucosum of the Knee Joint: A Descriptive Study

Background: The ligamentum mucosum (LM), or the infrapatellar plica, is a synovial fold of the knee joint that extends between the infrapatellar pad of fat and the intercondylar notch of the femur. LM has been implicated in plica syndrome, a painful knee condition caused by thickened, fibrotic, and edematous synovial plicae. LM can be used to reconstruct an anterior cruciate ligament tear. The present cadaveric study aims to describe the gross and histological features of LM. Methodology: In 20 adult cadavers, the intra-articular structures of the knee joint were exposed by reflecting the patella. LM and its type were identified. The length, width, and thickness were measured. The structure of LM was studied using hematoxylin and eosin stains. Results: LM was present in all the knees. Type 1 was predominant with a single band and was observed in 85%. Type 2a and type 2b were presented with double bands and triple bands, respectively. Type 3 LM was a vertical septum dividing the joint cavity into two compartments. The length of the ligament was 28.16 ± 2.35 mm. The thickness of LM at the proximal and distal end was higher on the left side, which was statistically significant. LM was composed of dense connective tissue and had rich vascularization. Conclusion: LM was initially thought to be incidental, but recent studies have changed the view, and the present study confirms its presence and describes its anatomical features. Knowledge about the LM is necessary to evaluate anterior knee pain when no other pathology is detected.

Knee Pain Examined under Musculoskeletal Ultrasonography: Experience from a Community-based Rheumatology Practice – A Cross-sectional Study

Background: Diagnostic musculoskeletal ultrasonogram (MSUS) in musculoskeletal pain practice has increased. MSUS helps delineate extra-and intra-articular structures that are not visible on X-ray. Objective: Explore knee pain under ultrasonogram in a primary care rheumatology (PCR) facility. Methods: This cross-sectional study was performed over six months (January 1 and June 30, 2021) to explore knee pain in a community-based PCR setting. A physician registered in musculoskeletal (RMSK) ultrasonogram examined all patients and documented data in a prefabricated questionnaire. Statistical Package for the Social Sciences (SPSS, 28.0.1.1) was used to analyze data. Quantitative and categorical variables were presented with frequency and percentage. The Mann-Whitney-U test assessed the correlation between categorical variables; p<0.05 was considered statistically significant. Results: A total of 118 knees of 92 patients were included. Following are MSUS-depicted structural changes: medial joint line osteophytes (91.3%), medial femoral condyle (MFC), cartilage echogenicity (78.3%), synovial plica (76%), knee effusion (61.9%), synovial membrane thickening (54.3%), increased medial collateral ligament (MCL) thickness (42.4), reduced trochlear and MFC thickness (36.9%), Baker's cyst (35.8%), increased MFC thickness (31.5%), medial meniscal extrusion (MME) (27.2%), synovial hypertrophy (20.6%), increased trochlear cartilage thickness (20.6%), MM tear (18.5%), semitendinosus (SMT) bursitis (6.5%), loose body (6.5%), frond-like synovial mass (5.4%), MCL calcification (4.3%) and MM cyst (4.3%). There was a statistically significant correlation between the following variables: Knee effusion and synovial plica; reduced MFC thickness; MME and reduced MFC thickness and moderate osteophyte. Conclusion: High-frequency diagnostic ultrasound can depict knee pathology precisely. MSUS at the primary healthcare facility can minimize patient referral and burden over the tertiary setting and reduce overall expenditure.

Synovial plica of the elbow — detailed measurements and how to implicate its relevance in clinical practice

PurposeThe synovial plica of the elbow is a fold of synovial tissue, which is said to be a remnant of the embryonic septa of normal articular development and is located around the radiocapitellar joint. The objective of the present study was to provide morphometric properties of the synovial plica of the elbow and its relation to surrounding structures in asymptomatic patients.MethodsA retrospective study was conducted to establish the morphometric characteristics of the synovial plica of the elbow. The results of 216 consecutive patients, who for different reasons during the five year period of time underwent magnetic resonance imaging (MRI) of an elbow, were analyzed.ResultsPlica was found in a total of 161 of 216 elbows (74.5%). The mean width of the plica was set to be 3.00 mm (SD: 1.39). The mean length of the plica was established at 2.91 mm (SD: 1.13). An analysis of sexual dimorphism was also included. Potential correlations were analyzed for each of the categories and age.ConclusionsThe synovial plica of the elbow is a clinically relevant anatomical structure. Analyzing the morphometric parameters of the synovial plica is necessary to properly evaluate synovial plica syndrome, which can commonly be confused with other sources of lateral elbow pain such as tennis elbow, oppression of the radial and/or posterior interosseous nerve, or snapping of the triceps tendon. The authors suggest that the thickness of the plica may not be the golden diagnostic feature as there are no statistically significant differences in this parameter between symptomatic and asymptomatic patients. A precise and accurate diagnosis of synovial fold syndrome and/or differentiation from other sources of lateral elbow pain must be performed, as the surgical treatment, even if performed properly, will be unsuccessful because of a misdiagnosed source of pain.

Reduplicated medial parapatellar plica: a case of a medial plica anatomical variation recalcitrant to conservative treatment

PurposeThe current study aims to report the radiologic and clinical appearance of a rare anatomical variation of the knee medial synovial plica along with its response to conservative and surgical treatment.Case presentationThis report portrays a 29-year-old male patient with anteromedial gradual onset right knee pain, aggravated when descending stairs or prolonged sitting. Physical examination revealed medial parapatellar local tenderness, a palpable click in this area when the knee was extended, and hamstring tightness. Magnetic resonance imaging showed a duplicated medial plica, characterized by a high-intensity signal of the infrapatellar fat pad medial portion, after which a presumptive diagnosis of medial plica syndrome was proposed. After conservative treatment failure, the patient underwent standard knee arthroscopy that revealed a superior low profile and an inferior high profile medial plica, and hypertrophy of the medial portion of the infrapatellar fat pad. Both plicae and fat pad were resected with a mechanical shaver until no contact between the femoral trochlea and the fat pad was observed during full range of motion. At 4 weeks postoperatively, symptoms completely resolved, and the patient was allowed to return to full activity with no recurrences at 1 year follow-up.ConclusionsThe current study presented a rare anatomical variation of the knee medial synovial plica that was symptomatic and recalcitrant to conservative treatment. This case report may be useful for radiologists and orthopaedic surgeons to differentiate this special plica type and consider its response to conservative and surgical treatment during patient management.

Role of magnetic resonance imaging in assessment of extensor compartment abnormalities of knee joint – A cross-sectional study

INTRODUCTION: The patellofemoral joint (PFJ) is a complex joint structure with high functional and biomechanical requirements. The magnetic resonance imaging (MRI) is an effective tool for definition and characterization of knee pathology as it can accurately detect, localize, and characterize various pathologies of the knee joint. OBJECTIVES: (1) Evaluate MR images to identify different pathologies that are seen in the extensor compartment of the knee joint. (2) Quantitative assessment of patellofemoral measurements to determine predisposing risk factors that contribute to patellofemoral joint instability. METHODOLOGY: A cross-sectional study was conducted from January 2017 to December 2017 with a sample size of 30 in the Department of Radiodiagnosis at The KLE's Dr. Prabhakar Kore Hospital and MRC, Belagavi. The data were collected using a pretested semi-structured questionnaire. The pro forma included sociodemographic profile of the study subjects, clinical presentation MRI to identify different pathologies that are seen in extensor compartment of the knee joint and quantitative assessment of patellofemoral measurements to determine predisposing risk factors that contribute to patellofemoral joint instability. RESULTS: Among the study population majority of people had normal synovium, laterally subluxated/dislocated patella. Among the study population, the majority had normal lateral trochlear inclination angle, normal trochlear facet asymmetry, normal trochlear depth, normal sulcus angle, and trochlear dysplasia. Twenty-four (80%) people had normal Insall–Salvati index, 27 (90%) people had normal lateral patella femoral angle, 25 (83.30%) people had normal lateralization of the patella, 28 (93.30%) people had normal tibial tubercle to trochlear groove distance, majority, i.e., 11 (36.70%) had Hoffa's fat pad edema followed by chondromalacia patella, trochlear dysplasia, medial patellofemoral ligament tear, patella alta, synovial plicae, subluxated/dislocated patella, transient dislocated patella, Osgood–Schlatter disease, and patellar tendonitis. CONCLUSION: MRI has also been useful in identifying extensor compartment pathologies that lead to anterior knee pain.

Magnetic resonance imaging appearance of breaststroker’s knee

Breaststroker’s knee is an overuse syndrome resulting from similar repetitive movements in competitive swimmers that has been described in the orthopedic literature. The typical symptoms are medial knee pain with tenderness to palpation at the tibial collateral ligament or inferomedial patella. Despite these localizing symptoms on clinical exam, arthroscopic studies have failed to demonstrate a specific structural abnormality corresponding to this syndrome, although some have reported thickened medial synovial plica, medial-predominant synovitis or patellofemoral cartilage loss in association knee pain with breaststroke swimmers. We present a case of medial knee pain in a young breaststroke swimmer with magnetic resonance imaging (MRI) findings of marrow edema in the anterior aspect of the medial femoral condyle. To our knowledge, this is the first reported case of MRI findings in breaststroker’s knee .

Assessment of Clinical and Functional Outcomes of Treating Clinically Diagnosed Plica Syndrome in a Pediatric Population

Knee pain is one of the most common complaints in pediatric clinics, accounting for nearly one third of visits. Plica syndrome is one cause of pediatric knee pain that typically results from a traumatic event or due to overuse. Synovial plicae are normal anatomic findings thought to be embryologic remnants from the three compartments that develop into the knee. Plicae are associated with knee pain caused by trauma or repetitive movements that lead to inflammation; most commonly the medial plica.

Arthroscopic surgery results for plica syndrome of the knee

Aim. This study aimed to carry out a comparative analysis of the treatment results in patients with plica syndrome of the knee. Methods. A total of 425 patients are contributed in the study done during 2018-2019 (main group) and 2014-2017 (comparison group). The main group was consisted of 205 patients who underwent early arthroscopic surgery as the main treatment. The comparison group was consisted of 220 patients who were prescribed conservative therapy for 3 months as the first stage of treatment; in case of ineffectiveness, arthroscopic diagnostics were performed, followed by surgical correction of the pathology of the synovial plica of the knee. Evaluation of the results was carried out after 1 and 3 months (early and immediate postoperative period), 6 and 12 months (long-term postoperative period), and was based on the data of clinical (complaints and physical examination), instrumental (ultrasound and MRI) examination and test results on the scale Lysholm and a special questionnaire IKDC-2000 by comparing these indicators with the data before and after the surgical treatment of patients. Results. The share of excellent and good long-term results was increased from 80.4% to 92.7%, the frequency of specific complications was reduced from 17.3% to 5.4%. Arthroscopic surgery provided successful therapy in 94.6% of cases in patients with pathological synovial folds of the knee. Long-term rehabilitation of more than 6 months was required in 5.4% (11 out of 205) cases, in particular with recurrent synovitis (7 out of 11; 63.6%), chronic pain in the patellofemoral joint (2 out of 11; 18.2%) and the presence of movement restrictions in the knee joint (2 out of 11; 18.2%). Conclusion. The early use of arthroscopic surgery of pathologically altered synovial folds of the knee joint is accompanied by a positive dynamics of points on the Lysholm scale and the IKDC-2000 questionnaire during treatment and is characterized by the possibility of regression of the intra-articular pathological process with a significant increase in the proportion of excellent and good results in the immediate and late postoperative periods.

Arthroscopic treatment and mid-term results of suprapatellar plica syndrome: a single-center experience of 14 cases

Objectives: Synovial plicae syndrome (SPS) are encountered as a mesenchymal tissue remnant during the process of embryological development, and divide the knee joint into three separate compartments. Of these, the suprapatellar plica may be affected by a syndrome that manifests with anterior knee pain, a clicking sound, snagging and a feeling of skipping after a patellofemoral overload. The present study evaluates 14 patients with suprapatellar complete plica syndrome who were treated between 2013 and 2019, and discusses the medical and surgical medium-term results of the condition. Methods: Included in the study were 225 cases who underwent knee arthroscopy between 2013 and 2019, the data of which were analyzed retrospectively. The exclusion criteria were accompanying meniscal tear, anterior and posterior cruciate ligament tears, chronic inflammatory arthritis, varus > 3˚ and valgus > 5˚ malalignments. The cases were followed-up using the Tegner Lysholm knee scoring method, during the preoperative period, in the postoperative period, and in postoperative week 12 and month 6. The statistical analysis was performed using the IBM SPSS Statistics (Windows Version 25.0. Armonk, NY: IBM Corp.) software package. Results: A retrospective analysis revealed a BMI of 28.7 ± 5.6 kg/m2 in the 14 cases. The mean age was 34.57 ± 8.53 years. Intraarticular cortisone injections and intraarticular viscosupplementations were performed at the outpatient follow-up in eight and three cases, respectively. Furthermore, eight cases had undergone previous physical therapy and rehabilitation. The mean duration of symptoms was 1.4 ± 0.8 months. The Tegner Lysholm knee scores were 69.53 ± 6.15, 88.23 ± 3.00, and 93.76 ± 3.83 in the preoperative period, week 12 and month 6, respectively. Conclusions: In conclusion, arthroscopy can be considered an efficacious and diagnostic method in knee plica syndrome. Patient satisfaction is high in the medium-term.

Dynamic ultrasonic research mediopatellary synovial folding knee joint

BACKGROUND: One of the reasons for the formation of pain syndrome in the anterior part of the knee joint is a pathologically thickened mediopatellar synovial plica (MP). MP most often pathologically changes and as a result leads to changes in the nearby structures of the knee joint. However, there are difficulties in assessing the direct impact of MPSS on the articular cartilage of the patella and medial condyle of the femur, for this it is advisable to perform ultrasound examination using functional tests.
 AIM: To study the effectiveness of ultrasound examination with the use of functional tests in the diagnosis of MP pathology, which are important in determining tactics and evaluating treatment results.
 MATERIALS AND METHODS: The results of a comparative survey of 80 patients are presented. The first stage of the MRI was performed on patients, according to which the type of change in MP was evaluated. The second stage was ultrasound with the use of functional tests.
 RESULTS: According to MRI data, type A was detected in 11, type B in 17, type C in 38 and type D in 14 patients. Ultrasound results showed that type A and B MP were not infringed in any case, and type C and D MP were infringed in 24 (63.2%) and 12 (85.7%) cases, respectively.
 CONCLUSION: The study made it possible to determine not only the presence or absence of pathologically thickened MP, but also to assess the degree of its influence on nearby joint structures, such as thickness, the degree of vascularization of both the fold itself and the synovial membrane around it, the presence or absence of infringement during flexion and extension of the knee joint and SHELF syndrome, and therefore, the degree of its participation in the formation of pain syndrome.

Infrapatellar plica injury: Magnetic resonance imaging review of a neglected cause of anterior knee pain.

Synovial plicae are normal remnants of synovial membranes within the knee joint cavity and are usually asymptomatic. Pathological infrapatellar plica, which is mostly due to plica injury, may be a potential cause of anterior knee pain, but is often overlooked and under-reported on magnetic resonance imaging (MRI). This pictorial review illustrates the MRI findings of infrapatellar plica injury and associated knee injuries, with emphasis on its differentiation from the mimics of plica injury.

Arthroscopic Tennis Elbow Management: Prospective Cohort Study

Description of and Prospective analysis of long-term outcomes of arthroscopic tennis elbow release. 70 patients (72 elbows) with lateral epicondylitis, recalcitrant to a minimum of 6 months of supervised conservative management, underwent arthroscopic lateral epicondylar release. Each patient was clinically evaluated pre operatively and post-operatively and a quantitative assessment of the grip strength was collected on both sides with a dynamometer, in full elbow extension and in 90 degrees flexion. Functional assessment with the Mayo Elbow Performance Score and dynamometer grip strengths were collected for the first two years post-operation. Postoperative follow-up averaged 36 months (range 24-45months). The average MEPS increased from 57/100 to 89/100. 66 patients were graded as excellent outcomes, and 4 patients were noted to have fair outcomes. The latter 4 patients were assessed to have type 2 failure, with two subsequently requiring PIN releases, one requiring an osteochondroma excision from the distal lateral humerus, and one patient lost to follow-up. Dynamometer strength returned to above pre-operative level at an average of 3 months and were and average of 35% greater than the pre-operative level at final review. Complications consisted of synovial fistulae (n=8) all of which spontaneously resolved within one month, 2 portal superficial infections, 1 mild anterior capsular contracture, and no neurovascular injuries. Concurrent intra-articular pathology that was noted included radio-capitellar chondrosis (n=22), lateral trochlear chondrosis (n=20), anterolateral synovial plicae (n=17), synovitis (n=13), radial head instability (n=3), and synovial osteochondromatosis (n=1). Arthroscopic tennis elbow release is a valid technique for the treatment of recalcitrant lateral epicondylitis. The results show that pain relief and strength improve significantly up to 3 months post-surgery, and continue to improve for the first 12 months, with little improvement beyond that time.

Systematic Review of the Surgical Outcomes of Elbow Plicae.

Background:Surgical resection is usually required for symptomatic elbow plicae that have failed nonoperative therapy. However, evidence of surgical outcomes has not been presented.Purpose:To review the surgical outcomes for the treatment of synovial plicae in the radiocapitellar joint.Study Design:Systematic review; Level of evidence, 4.Methods:We searched the PubMed, Ovid/MEDLINE, Cochrane Library, Google Scholar, and Embase databases using keywords as well as Medical Subject Headings terms and Emtree ([(elbow OR humeroradial joint OR radiohumeral joint) AND (meniscus OR plica)] OR snapping elbow OR snapping triceps OR synovial fold syndrome OR synovial fringe) for English-language studies. We conducted a systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.Results:A total of 14 articles comprising four level 5 and ten level 4 studies were identified, including 279 patients (284 elbows). The triggering factors reported for 58 patients were heavy labor (29 patients; 50.0%), sporting activities (17 patients; 29.3%), and nonspecific trauma (12 patients; 20.7%). Overall, 92 patients (33.0%) were administered a steroid injection before surgery. Arthroscopic plica resection was performed in 266 patients (95.3%). Intraoperatively, plicae were mostly found in the posterior (44.0%) and posterolateral (28.6%) sites, and chondromalacia of the radial head was observed in 25 patients (9.2%). Of the reported surgical outcomes, 67.7% showed a resolution of symptoms. However, 9.3% of patients had residual symptoms, which were likely associated with pre-existing radial head chondromalacia. The complication rate was reported as 1.8%.Conclusion:Symptomatic elbow plicae were mostly treated arthroscopically, with most of the results being favorable. Pre-existing chondromalacia and the underestimation of concomitant intra-articular abnormalities may yield an inferior outcome.

Arthroscopic evaluation of the metacarpophalangeal and metatarsophalangeal joints in horses with parasagittal fractures of the proximal phalanx.

Fractures of the proximal phalanx are one of the most common long bone fractures of Thoroughbred racehorses. Although the degree of disruption and damage to the articular surface is generally considered a major prognostic determinant, associated arthroscopic findings have not previously been reported. To describe the metacarpo/metatarsophalangeal (MCP/MTP) joint lesions associated with parasagittal fractures of the proximal phalanx arthroscopically identified at the time of fracture repair and compare radiographic and arthroscopic appearance of complete fractures. Retrospective case series. Case records and arthroscopic images of horses with parasagittal fractures of the proximal phalanx admitted to Newmarket Equine Hospital from 2007 to 2017 were analysed. 81 MCP/MTP joints in 78 horses underwent arthroscopic evaluation concurrent to parasagittal fracture repair. Tears of the joint capsule and dorsal synovial plica were noted in 43 cases. Arthroscopy identified articular incongruity in three horses where fracture displacement was not predicted at all on pre-operative radiographs, and incongruity in additional plane(s) to the radiographic displacement in 14 horses. Concurrent osteochondral fragmentation and disruption of cartilage were present in some cases. As a retrospective study, the arthroscopic data available for review were variable. Arthroscopic assessment of fracture reduction and joint congruency was evaluated in all cases but there was variation in the completeness of evaluation of the entire dorsal joint space of the fetlock joint. This may have led to the underestimation of soft tissue lesions in these cases. Some horses suffering from parasagittal proximal phalanx fractures have concurrent tearing of the joint capsule and/or dorsal plica, which may have relevance in the acute course of events resulting in the development of fractures. Fracture displacement and incongruency at the articular surface cannot confidently be excluded pre-operatively by radiographs alone.

Synovial plica of the elbow and its clinical relevance.

A synovial plica (fold) is normal anatomic finding, and occurs in 86–100% of cases; however, symptomatic plica is much less common (7.2–8.7% of all elbow arthroscopies).Synovial plica syndrome is a painful elbow condition related to symptomatic synovial plica.Synovial plica syndrome is diagnosed by clinical examination (lateral elbow pain) commonly accompanied by local tenderness, pain at terminal extension and/or painful snapping.Synovial plica syndrome may be mimicked by other elbow conditions, commonly tennis elbow, loose bodies, and degenerative arthritis.Magnetic resonance imaging or ultrasound scan may support diagnosis in correlation with clinical findings, but symptomatic plica may also be diagnosed as unexpected during elbow arthroscopy.The arthroscopic resection is effective and safe if conservative treatment fails.Cite this article: EFORT Open Rev 2020;5:549-557. DOI: 10.1302/2058-5241.5.200027

Arthroscopic Modified Bosworth Procedure for Refractory Lateral Elbow Pain With Radiocapitellar Joint Snapping.

Background:Radiocapitellar joint snapping due to the presence of synovial plica has been described as a contributory intra-articular pathology of lateral epicondylitis (LE).Hypothesis:The arthroscopic modified Bosworth technique can provide a safe and favorable outcome for refractory LE with radiocapitellar snapping.Study Design:Case series; Level of evidence, 4.Methods:Patients treated with the arthroscopic modified Bosworth procedure for refractory LE with radiocapitellar joint snapping were included in this study. The sequential surgical procedures included excision of the upper portion of the anterolateral annular ligament, removal of the synovial plicae, and release of the extensor carpi radialis brevis for all patients. Clinical outcomes were measured at a minimum 1-year follow-up.Results:A total of 22 patients with a mean ± SD age of 51.2 ± 10.4 years were included in this study. The mean follow-up was 29.4 ± 7.7 months (range, 21-42 months). The overall visual analog scale score (from preoperative to final follow-up) was 7.5 ± 1.2 vs 2.5 ± 1.8 (P < .001); flexion-extension motion arc was 133.8° ± 11.2° vs 146.4° ± 7.1° (P = .001); pronation-supination motion arc was 101.8° ± 9.2° vs 141.7° ± 10.2° (P = .001); Disabilities of the Arm, Shoulder and Hand score was 54.5 ± 13.2 vs 3.6 ± 4.1 (P < .001); and Mayo Elbow Performance Score was 51.9 ± 12.2 vs 84.3 ± 10.3 (P < .001).Conclusion:Radiocapitellar joint snapping may coexist with LE as a disease spectrum. The arthroscopic modified Bosworth technique provides safe and favorable outcomes for patients with refractory LE associated with radiocapitellar joint snapping.

A Comprehensive Review of Radiohumeral Synovial Plicae for a Correct Clinical Interpretation in Intractable Lateral Epicondylitis

Radiohumeral synovial plicae (RHSP) have been studied by different authors in different ways; in spite of this, the evidence is poor and the results are controversial and inconclusive even when it comes to referring to this elbow structure. The aim of this article is to review the embryologic development, anatomy and histology, pathophysiologic features, clinical manifestations, physical examination, imaging findings, and treatment of radiohumeral synovial plicae, for their correct clinical interpretation in patients with intractable lateral epicondylitis. Radiohumeral synovial plicae syndrome (RHSPS) can cause intractable lateral epicondylitis and can be easily confused with other clinical conditions affecting the elbow. Many clinicians are not familiar with radiohumeral synovial plica syndrome since there are not many studies about it and previous reports do not seem to reach a consensus. Although its role in elbow injuries and epicondylitis is accepted and its surgical treatment is effective, there is no clear consensus about clinically relevant aspects. RHSP are remnants of normal embryo development of the articular synovial membrane with different anatomical locations, size and shape. Traumatism or overuse can turn RHSP into symptomatic structures at any age and can be compressed between the radial and humeral heads during movement. This compression can cause pain and other symptoms such as snapping, catching, mobility restriction, pitching, clicking, locking, blockage, popping and swelling. Radiohumeral synovial plica syndrome (RHSPS) may be an isolated condition or it can be associated with other elbow abnormalities. The findings on physical examination and imaging diagnosis are multiple and variable. Nowadays, RHSPS are quite unknown and previous reports do not seem to agree, leading to misdiagnoses as epicondylitis and making this structure the main cause of some cases of "intractable lateral epicondylitis". The outcomes of surgical treatments are quite promising although more, higher quality research is needed. Taking this into account, this review is meant to be a starting point for new anatomical and clinical studies.

Correlation of Arthroscopic and Histologic Findings in Synovial Membrane Disease of the Temporomandibular Joint

The purpose of the present study was to correlate specific arthroscopic findings in temporomandibular joint (TMJ) arthroscopy and histologic results from arthroscopic-guided synovial biopsy. A retrospective cohort study was completed of patients who had undergone arthroscopy and arthroscopic synovial biopsy from January 1, 2011 to March 31, 2016 at the senior author's practice in Miami, Florida. The demographic, arthroscopic, histologic, serologic, and historical variables were recorded by electronic medical record review. Two-tailed Fisher's exact tests were used to test the correlation of the arthroscopic and histologic variables. A total of 210 patients were included in the present study. The mean age was 43.1±18.8years, and the study population included 91.7% women. The following histologic findings had significant associations: lymphoplasmacytic infiltrate with petechiae synovitis (P=.0018), chronic inflammation with joint stenosis (P=.019), and crystal deposition with visualization of crystals (P=.0472). Hyperplastic synovium found on histologic examination was associated with both petechiae synovitis and adhesions. Histologic vascular proliferation was associated with synovial plica and joint stenosis. The findings from the present study indicated an association between specific findings during arthroscopy and histologic findings. A prospective study is required to validate the findings to evaluate their utility in patient care.

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.