Synovial Plica Syndrome of the Knee: A Commonly Overlooked Cause of Anterior Knee Pain

Lee, Paul Y F; Nixion, Amy; Chandratreya, Amit; Murray, Judith M.

doi:10.1055/s-0037-1598047

Cited by 38 publications

(38 citation statements)

References 29 publications

(57 reference statements)

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“…Although this disease should be suspected in patients at any age, it is less common among children below 10 years old. 3 Dull knee pain is a common symptom, and the pain is often aggravated during stair climbing. 2 , 8 On physical examination, patients have tenderness over the upper edge of the patella.…”

Section: Discussionmentioning

confidence: 99%

“… 3 Synovial knee plicae have recently been classified into four types according to their location: suprapatellar, infrapatellar, medial, and lateral. 3 , 4 Of these, the medial or “shelf” plica has the pathological potential to be associated with knee symptom. 5 , 6 , 7 However, the pathological contribution of suprapatellar plicae to knee symptoms has seldom been reported, and suprapatellar plica syndrome appears to be overlooked or misdiagnosed occasionally.…”

Section: Introductionmentioning

confidence: 99%

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Suprapatellar plica classification and suprapatellar plica syndrome

Akao

Ikemoto

Takata

et al. 2019

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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Background Plicae around the knee are anatomically normal structures that are remnants of embryonic membranes and are generally asymptomatic. Synovial plica syndrome is known to cause knee symptoms; however, its pathological contribution has been rarely reported. This study aimed to investigate the clinical significance of suprapatellar plicae as well as the morphological characteristics of suprapatellar plicae in patients with knee symptoms who required arthroscopic treatment. Methods Of 223 arthroscopic knee surgeries, 125 patients undergoing primary arthroscopy for various diseases were eligible for inclusion in this study. All affected knees were preoperatively examined by two skilled physicians in a routine manner. Each patient was diagnosed with one primary disease entity based on clinical examinations and arthroscopic findings. At least two skilled orthopedic physicians watched the surgical videos together and defined the type of plicae based on the Dandy classification (Dandy DJ. 1990) as follows: (A) absent, (B) the plica was up to one-quarter of the width of the suprapatellar pouch, (C) the plica was between one-quarter and one-third of the width of the suprapatellar pouch, (D) the plica was between one-third and two-thirds of the width of the suprapatellar pouch, (E) the plica was more than two-thirds of the width of the suprapatellar pouch, (F) the plica had a complete membrane, (G) the plica was perforated, (H) arch, (I) pillar, or (J) lateral. Suprapatellar plica syndrome was considered when (1) the patient complained of anterior knee pain and had localized tenderness above the suprapatellar pouch, (2) magnetic resonance imaging revealed suprapatellar plica structures, and (3) other suspicious pathologies accounting for knee symptoms were excluded. We investigated primary disease type, type of plica, and the relationships between them. Results The results revealed that meniscus injuries and anterior cruciate ligament injuries caused the majority of primary diseases (approximately 80%). Regarding plica forms, 23 knees were classified as having absent (type A) plicae, 14 knees as having a complete septum (type F), and 88 knees were classified as “other.” There were no significant relationships between disease type and the morphological characteristics of the plicae (chi-squared test, p = 0.35). Suprapatellar pain was observed in five cases, of which two patients were diagnosed with intra-articular free body, one patient with synovitis combined osteoarthritis, and two patients with suprapatellar plica syndrome with a complete septum. The latter two cases experienced knee symptom resolution soon after arthroscopic resection of the plica. Conclusions Although the results did not show any relationship between forms of plica remnants and primary disease type, all patients diagnosed with suprapatellar plica syndrome showed complete septum type suprapatellar plicae. A large population study is required in...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Suprapatellar plica classification and suprapatellar plica syndrome

Akao

Ikemoto

Takata

et al. 2019

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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“…A normal synovial plica is a soft and elastic structure, whereas a pathological plica is commonly inelastic, tight, thickened, fibrotic and sometimes hyalinized. Bowstringing across the femoral trochlea may cause impingement between the patella and femur in knee flexion and a nonspecific anterior or anteromedial knee pain, which results in synovial plica syndrome (Lee et al 2017).…”

Section: Anatomical Features Prevalence and Incidence Of The Synoviamentioning

confidence: 99%

The infrapatellar fat pad and the synovial membrane: an anatomo‐functional unit

et al. 2018

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The infrapatellar pad, a fibro-adipose tissue with peculiar microscopic and mechanical features, is gaining wide attention in the field of rheumatological research. The purpose of this descriptive review is to summarize the most recent published evidence on the anatomic, physiologic and biomechanical inter-relationship between the infrapatellar fat pad and the knee synovial membrane. As an extrasynovial tissue, the infrapatellar fat pad does not directly interact with the articular cartilage; based on its location in close contact with the synovial membrane, and due to the metabolic properties of adipose tissue, it may influence the behavior of the synovial membrane. In fact, considering evidence of macroscopic and microscopic anatomy, the infrapatellar fat pad is the site of insertion of the infrapatellar and medial synovial plicae. Also biochemically, there is much evidence highlighting the interaction among these two structures; in the case of inflammation, the mutual interplay is ascribable to the release of pro-inflammatory mediators stimulating the proliferation of inflammatory cells and promoting tissue modifications in both. All these assumptions could support the emerging idea that the infrapatellar fat pad and the synovial membrane may be considered a morpho-functional unit.

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“…Процедуру традиционно выполняли с использованием механических инструментов. Совсем недавно предложено применение внутрисуставной электрокоагуляции или радиочастотных устройств [78,83]. Патологические складки должны быть полностью иссечены из-за тенденции оставшихся тканей к формированию складчатых структур [12].…”

Section: Introductionunclassified

“…Соответствующие послеоперационные реабилитационные мероприятия позволяют большинству пациентов вернуться к занятиям спортом в сроки от 3 до 6 недель [10,83].…”

Section: Introductionunclassified

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

Baburkina¹

2020

ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS

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Synovial Plica Syndrome of the Knee: A Commonly Overlooked Cause of Anterior Knee Pain

Cited by 38 publications

References 29 publications

Suprapatellar plica classification and suprapatellar plica syndrome

Suprapatellar plica classification and suprapatellar plica syndrome

The infrapatellar fat pad and the synovial membrane: an anatomo‐functional unit

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

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