Systematic Review of the Surgical Outcomes of Elbow Plicae

Abstract

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.

A Rare Intra-articular Abnormality in the Posterior Radiocapitellar Joint: A Case Report

“…Various intra-articular soft-tissue abnormalities of the radiocapitellar joint have been reported in clinical and cadaveric studies [ 4 , 5 , 6 ]. These abnormalities include synovial plicas, folds, masses, cords, bands, and fringes; menisci; meniscoids; and meniscocapsular complexes.…”

“…Unlike anterior synovial folds, which have been arthroscopically classified, posterior synovial folds or other abnormalities have not been classified. Most posterior intra-articular abnormalities are interposed in the radiocapitellar joint, leading to catching or locking of the elbow [ 4 , 5 , 6 ]. To the best of our knowledge, tendon-like intra-articular abnormalities similar to that in this case have not been reported in clinical or cadaveric studies.…”

Technical Note: Arthroscopic Resection of Snapping, Interponating Annular Ligament of the Elbow

“…Most of the surgical interventions were performed arthroscopically, also with the advantage of clarifying other intra-articular pathologies. Overall, the outcome results are good to excellent, although the authors critically note that no standardized outcome measures were used 3 , 4 , 8 , 10 . In particular, no functional scores were evaluated that included not only pain but also limited range of motion, the other main symptom.…”

“…In particular, no functional scores were evaluated that included not only pain but also limited range of motion, the other main symptom. Some studies reported residual symptoms of pain and persistent mechanical irritation (approximately 9.3%) 3 , 10 . The studies do not provide a detailed rationale for this phenomenon, but it is postulated that primarily the associated chondromalacia of the radial head may be the cause of persistent symptoms 1 , 10 .…”

“…Parts of the annular ligament, meniscus-like structures, or a hypertrophic synovial fold may interpose in the radiohumeral joint and cause entrapment symptoms. Jeon et al describe the surgical outcome for elbow plicae in a systemic review [10]. Most of the surgical interventions were performed arthroscopically, also with the advantage of clarifying other intra-articular pathologies.…”