Abstract:Synovial plicae are vestigial folds of synovium in a joint, most widely recognized in the knee and also in the elbow and hip joints. The most commonly shared theory on the origin of plicae is that they are the remnants of the membranes that divide the synovial cavitations during normal joint development. Synovial folds do not generally cause any symptoms. However, they can become inflamed, thickened, fibrosed, and also impinged in the joint, leading to mechanical symptoms and chondral damage. This article pres… Show more
“…There are limited data regarding synovial plica in TMJ, exemplified by the few reports on the incidence of synovial plicae. In orthopedics, the MRI is useful to detect the presence of plica and arthroscopy is the gold standard for the diagnosis [1][2][3][4][5]. But in TMJ plicae, routine 1.5 Tesla MRI is insufficient to detect intra-articular detail of structures ( 30) such as plicae.…”
Section: Discussion and Prospectivementioning
confidence: 99%
“…The epidemiology of the prevalence of symptomatic plicae has not been clarified. The orthopedic literature indicates the usefulness of MRIs as a diagnostic modality and arthroscopy as a gold standard for diagnosis and as a treatment modality (1)(2)(3). An arthroscopically diagnosed synovial plica with evidence of inflammation and fibrosis, along with histologic confirmation is highly suggestive of a synovial plica with entrapment as a cause of symptoms (4).…”
Section: Synovial Plicae and The Tmjmentioning
confidence: 99%
“…In most extremities, joints such as the knee, hip, and elbow, the origin of plicae are the remnants of the membranes that divide the synovial cavitations during normal joint development (2). On the contrary in the TMJ, the superior joint compartment is formed on the connective tissues of early articular disc and condyle.…”
Synovial plicae are common findings in most knees and extremity joints. However, plicae of the temporomandibular joint (TMJ) have not been adequately addressed. In the cadaver study, various plicae were observed with histologic findings in the research base, and clinically plica were detected in patients with internal derangement, recurrent luxation and other operative diseases in recent years. Although the incidence of a synovial plica varies between 24% with 62%, the prevalence is unknown because of not detectable by MRI. Plicae in recurrent dislocation cases are relatively thick, wide and pliable with histology of dense fibrous/hyalinized tissues with scattered chondroid cells. In cases with internal derangement, plicae were thin pliable, and finger-or band-like with histology of fibrous tissues and/or inflamed synovium with vascular proliferation suggesting in pathogenesis. Although plicae may or may not be causing symptoms, when detected during surgery should be removed with other intraarticular pathologies for restoring the biological function of TMJ. In development of TMJ lateral impingement, the lateral capsular prolapse may play an important role. The soft tissues of the capsule become fibrotic and constricted with inflammation restricting mandibular movement. Early adhesive capsulitis appears as an adherent finger-like plica vascularized from the lateral capsule restricting movement of the attached disc. Plica lined with synovium combined with a deformed disc induce mechanical abrasion resulting synovitis, which may induce chondromalacia leading to deterioration of bone and joint. The release of adhesions along the lateral aspect of the capsule is performed, then lateral capsular stretching and repositioning of prolapsed synovial plica is favorable to obtain good outcomes. The term "entrapment" generally refers to a compression of a peripheral nerve or artery usually between ligamentous and bony structures. Whereas symptomatic synovial impingement and intra-articular synovial entrapment syndromes have been well documented in patient undergone total arthroplasty and joint replacements of the hip and knee. There is strong evidence that the TMJ is susceptible to the same symptomatic impingement and intra-articular synovial entrapment as other synovial joints. This review of our current state of knowledge will accelerate and update the evolution of further understanding of TMJ pathologies, diagnosis and treatment.
“…There are limited data regarding synovial plica in TMJ, exemplified by the few reports on the incidence of synovial plicae. In orthopedics, the MRI is useful to detect the presence of plica and arthroscopy is the gold standard for the diagnosis [1][2][3][4][5]. But in TMJ plicae, routine 1.5 Tesla MRI is insufficient to detect intra-articular detail of structures ( 30) such as plicae.…”
Section: Discussion and Prospectivementioning
confidence: 99%
“…The epidemiology of the prevalence of symptomatic plicae has not been clarified. The orthopedic literature indicates the usefulness of MRIs as a diagnostic modality and arthroscopy as a gold standard for diagnosis and as a treatment modality (1)(2)(3). An arthroscopically diagnosed synovial plica with evidence of inflammation and fibrosis, along with histologic confirmation is highly suggestive of a synovial plica with entrapment as a cause of symptoms (4).…”
Section: Synovial Plicae and The Tmjmentioning
confidence: 99%
“…In most extremities, joints such as the knee, hip, and elbow, the origin of plicae are the remnants of the membranes that divide the synovial cavitations during normal joint development (2). On the contrary in the TMJ, the superior joint compartment is formed on the connective tissues of early articular disc and condyle.…”
Synovial plicae are common findings in most knees and extremity joints. However, plicae of the temporomandibular joint (TMJ) have not been adequately addressed. In the cadaver study, various plicae were observed with histologic findings in the research base, and clinically plica were detected in patients with internal derangement, recurrent luxation and other operative diseases in recent years. Although the incidence of a synovial plica varies between 24% with 62%, the prevalence is unknown because of not detectable by MRI. Plicae in recurrent dislocation cases are relatively thick, wide and pliable with histology of dense fibrous/hyalinized tissues with scattered chondroid cells. In cases with internal derangement, plicae were thin pliable, and finger-or band-like with histology of fibrous tissues and/or inflamed synovium with vascular proliferation suggesting in pathogenesis. Although plicae may or may not be causing symptoms, when detected during surgery should be removed with other intraarticular pathologies for restoring the biological function of TMJ. In development of TMJ lateral impingement, the lateral capsular prolapse may play an important role. The soft tissues of the capsule become fibrotic and constricted with inflammation restricting mandibular movement. Early adhesive capsulitis appears as an adherent finger-like plica vascularized from the lateral capsule restricting movement of the attached disc. Plica lined with synovium combined with a deformed disc induce mechanical abrasion resulting synovitis, which may induce chondromalacia leading to deterioration of bone and joint. The release of adhesions along the lateral aspect of the capsule is performed, then lateral capsular stretching and repositioning of prolapsed synovial plica is favorable to obtain good outcomes. The term "entrapment" generally refers to a compression of a peripheral nerve or artery usually between ligamentous and bony structures. Whereas symptomatic synovial impingement and intra-articular synovial entrapment syndromes have been well documented in patient undergone total arthroplasty and joint replacements of the hip and knee. There is strong evidence that the TMJ is susceptible to the same symptomatic impingement and intra-articular synovial entrapment as other synovial joints. This review of our current state of knowledge will accelerate and update the evolution of further understanding of TMJ pathologies, diagnosis and treatment.
“…Several studies report evaluation of plica with conventional arthrography [ 270 – 274 ], some in combination with dMRA, while others used cMRI [ 275 , 276 ]. Additional studies suggest evaluation is best in the presence of a joint effusion or with arthrography [ 275 , 277 , 278 ]. Fig.…”
Objective
Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion.
Materials and methods
The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations.
Results
Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus.
Conclusion
Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
