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RESUMEN Introducción: la PS se puede presentar de forma aislada o asociada a otras enfermedades, pero su responsabilidad como causa de dolor de la articulación se justifica cuando no se detectan otras alteraciones intraarticulares que expliquen los síntomas o cuando se asocia a otras enfermedades y se observa la PS vascularizada e irritada. El diagnóstico positivo es difícil tanto desde el punto visto clínico como imagenológico, de allí que la artroscopia constituye el estándar de oro, para confirmar su presencia y realizar el tratamiento. Objetivo: evaluar la efectividad del tratamiento artroscópico en la percepción de la calidad de vida relacionada con la salud en 72 pacientes con plica sinovial. Método: se realizó un estudio de intervención terapéutica del tipo antes-después, prospectivo, longitudinal, cuasi - experimental, en el servicio de Ortopedia y Traumatología del Hospital Carlos Manuel de Céspedes de Bayamo, en el periodo comprendido de enero 2017 a diciembre 2018, al tratarse de un estudio cuasi-experimental, se llevó a cabo un análisis intragrupo, comparando los datos pre y postratamiento. Resultados: prevaleció el sexo femenino, en las edades comprendidas entre los 30 a 44 años, las plicas suprapatelares fueron frecuentes. La manifestación clínica más frecuente fue el dolor, seguido de la crepitación. La escala analógica visual mostró mejoría con disminución estadísticamente significativa. Conclusiones: se demostró la efectividad de la artroscopia. La complicación más frecuente fue la hemartrosis posquirúrgica.
ABSTRACT Introduction: PS can occur in isolation or associated with other diseases, but its responsibility as a cause of joint pain is justified when other intra-articular alterations that explain the symptoms are not detected or when it is associated with other diseases and the PS vascularized and irritated. Positive diagnosis is difficult both from a clinical and imaging point of view, hence arthroscopy is the gold standard, to confirm its presence and carry out treatment. Objective: to evaluate the effectiveness of arthroscopic treatment in the perception of health-related quality of life in 72 patients with synovial plica. Method: a prospective, longitudinal, quasi-experimental, before-after, therapeutic intervention study was carried out in the Orthopedics and Traumatology department of the Carlos Manuel de Céspedes Hospital in Bayamo, in the period from January 2017 to December 2018, As it was a quasi-experimental study, an intragroup analysis was carried out, comparing the pre and post-treatment data. Results: the female sex prevailed, in the ages between 30 to 44 years, suprapatellar plicae were frequent. The most frequent clinical manifestation was pain, followed by crepitus. The visual analog scale showed improvement with a statistically significant decrease. Conclusions: the effectiveness of arthroscopy was demonstrated. The most frequent complication was postoperative hemarthrosis.
RESUMO Introdução: A SP pode ocorrer isoladamente ou associada a outras doenças, mas sua responsabilidade como causa de dor nas articulações é justificada quando outras alterações intra-articulares que explicam os sintomas não são detectadas ou quando estão associadas a outras doenças e à PS vascularizado e irritado O diagnóstico positivo é difícil tanto do ponto de vista clínico quanto de imagem, portanto a artroscopia é o padrão-ouro, para confirmar sua presença e realizar o tratamento. Objetivo: avaliar a efetividade do tratamento artroscópico na percepção da qualidade de vida relacionada à saúde em 72 pacientes com plica sinovial. Método: um estudo de intervenção terapêutica prospectivo, longitudinal, quase experimental, antes e depois foi realizado no departamento de Ortopedia e Traumatologia do Hospital Carlos Manuel de Céspedes em Bayamo, no período de janeiro de 2017 a dezembro de 2018, Por se tratar de um estudo quase-experimental, foi realizada uma análise intragrupo, comparando os dados pré e pós-tratamento. Resultados: predominou o sexo feminino; nas idades entre 30 e 44 anos, as plicae suprapatelar foram frequentes. A manifestação clínica mais frequente foi dor, seguida de crepitação. A escala visual analógica mostrou melhora com uma diminuição estatisticamente significante. Conclusões: a eficácia da artroscopia foi demonstrada. A complicação mais frequente foi hemartrose pós-operatória.
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Objectives To discuss the diagnosis and treatment of patellar plica under arthroscopy.Methods A retrospective survey was performed in 75 cases with patellar plicas under arthroscopy from Jun.2008 to June.2012.All patients were admitted by the clinic.All the patients diagnosised by arthroscopy and clinical evidence, and cuted off under arthroscopy.After the operation, patients were followed-up in the clinic and by telephone for 12 to 60 months, according to the knee joint Lysholm scoring system to assess curative effect.Results All the patients with successful operation, the operation time was 15-25 minutes.All cases after the operation without complications such as infection, quicker recovery of joint function.After 12 to 60 months, 70 patients were followed up, the knee joint Lysholm excellent score was 92.9％.Conclusions Inferior patellar plica under is a type of knee joint synovial plica syndrome, the arthroscopic surgery can determine diagnosis and do effective treatment.
ABSTRACT
Synovial plicae around the knees are a relatively common occurrence. They have been the object of many clinical and anatomical researches, not only because of their intra-articular existence, but also for their painful symptomatology caused on knee joint. These plicae are excessive folds of synovial membrane and are remnants from embryonic septum, which were not properly absorbed during fetal development. These synovial plicae are divided anatomically, as location and existence, and are classified into suprapatellar, infrapatellar, medial patellar and lateral patellar plicae; being still each of these subdivided according to their appearance and juxtaposition. Material and methods: A retrospective literature review selected articles in PubMed and MEDLINE databases; papers were searched using the keywords: synovial plicae, knee, embryology, anatomy, histology and treatment. Results: In this literature review was verified the incidence about the types, shape, location, symptoms, pathophysiology, and the main methods of study for the verification of synovial plica and treatments. Conclusion: In summary, asymptomatic plica can become symptomatic due to a bucket‑handle tear following a twisting injury and lateral traction to the knee, when carefully diagnosed; a synovial plica represents a potential cause of pain in patients. After careful examination, arthroscopic resection of the bucket‑handle portion of the plica is sufficient for the improvement of the symptoms if conservative treatment of pathological plica fail.
Subject(s)
Humans , Knee/anatomy & histology , Synovial Membrane/embryology , Synovial Membrane/physiology , Arthroscopy/rehabilitationABSTRACT
Objective To explore whether or not the cartilage damage in the pathogenesis of pathologic synovial plicae is due to the matrix metalloproteinase. Methods The immunohistochemical method was used to detect the expression and distribution of matrix metalloproteinase-1(MMP-1) and tissue inhibitor of metalloproteinase-1(TIMP-1) in arthroscopically clarified pathologic synovial plicae and normal synovial plicae of the knee joint.Results The positive expression rate of MMP-1 and TIMP-1 had significant differences between the pathologic and normal synovial plicae(?~2=16.014,P=0.000;?~2=4.059,P=0.044).The expression of MMP-1 was positive in the synovial lining cells,monocytes,lymphocytes,endothelial cells,and chondrocytes,but negative in the normal synovial plicae.The TIMP-1 expression was only detected in the synovial lining cells and a small quantity of fibroblast cells.The immunohistochemical analysis revealed a greater number of positive cells and intensity of staining of MMP-1 than TIMP-1.Conclusions The development of pathologic synovial plicae may yield MMP-1 and TIMP-1 with unbalanced distributions,which may be the biological basis of the pathogenesis of cartilage destruction.
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A clinical application of the arthroscopy to the three hundred symptomatic knees were performed, and seven knees with a symptomatic seprated suprapatellar bursa were successfully managed and followed by arthroscopic surgery at the Department of Orthopaedic Surgery, Soon Chun Hyang University Hospital from May 1983 to May 1985. The results obtained are as follows; 1. Separated suprapatellar bursa may cause some internal derangement of the knee. 2. The incidence of the separated suprapatella bursa in our view was 5% that is, of 300 symptomatic knees. 3. Separated suprapatellar bursa may have to be excised under arthroscopy.
Subject(s)
Arthroscopy , Incidence , KneeABSTRACT
The role played by synovial plica in internal derangement of the knee has been increased recently. A clinical application of arthroscopy of the one hundred eighty patients were performed, and eighteen patients with a symptomatic plica were successfully managed and followed by arthroscopic surgery at the department of orthopaedic surgery, Soon Chun Hyang University Hospital from May 1983 to May 1984. The results were summerized as follows; 1. Arthroscopy is the most accurate diagnostic and operative methods for the investigation of the incidence, pathology, clinical significance and treatment of the synovial plica. 2. The incidence of the mediopatellar plica in our view was 41% that is, 74 of 180 symptomatic knee. 3. Arthroscopy is a practical and valuable procedure with minimal associated morbidity or complication. 4. The increased accuracy of diagnosis help to avoid unnecessary operations and to be basic methods of treatment on a better knowledge of the pathology.
Subject(s)
Humans , Arthroscopy , Diagnosis , Incidence , Knee , Pathology , Pathology, ClinicalABSTRACT
Over twenty per cent of adult knees have a synovial plica which always has possibility of changes into pathologic synovial plica symptomes and signs resembling those of other common internal derangement of the knee joint. Especially the young active patient who has a history of trauma to the knee should once be suspected incarcerated synovial plica not only the possibility of internal derangement. Four cases of symptomatic synovial plica experienced by authors are reported with available references.