Treatment of pathological synovial plicae of the knee

OBJECTIVE: To analyze the incidence, clinical significance, and clinical manifestations of pathological synovial plicae of the knee. MATERIAL AND METHODS: Between 2002 and 2006, 63 patients with pathological synovial plicae of the knee were studied. Of those 63 patients, 21 had the diagnosis confirmed by previously performed magnetic resonance imaging. All of the patients initially underwent conservative treatment for 90 days that involved strengthening and improving the flexibility of the muscles surrounding the knee as well as modification of their sports activities. RESULTS: A total of 55 patients improved after conservative treatment. Six of these patients eventually experienced a recurrence of symptoms, but the symptoms were not incapacitating in any of these patients. The other eight patients underwent arthroscopic removal of the synovial plica. Of these eight patients, six returned to their pretreatment physical activities, and two had persistent symptoms during physical activity. CONCLUSION: The presence of a synovial plica of the knee should be considered as a potential diagnosis in patients with knee pain, especially those who practice sports inappropriately. Conservative treatment is effective in most cases, and surgical treatment should be reserved for exceptional cases that do not improve with conservative treatment.

The effects of medial patellar plica on clinical diagnosis of medial meniscal lesion.

A prospective study involving 190 patients presenting with symptoms suggesting internal derangements of the knee was performed to demonstrate the likelihood of symptoms and signs produced by medial patellar plica to mimic those of medial meniscal lesions. Arthroscopic examination was done in each patient by an independent examiner after the establishment of clinical diagnoses. Only patients with isolated medial patellar plica (Group A, n = 54) and isolated medial meniscal lesion (Group B, n = 19) were further assessed. Although isolated medial patellar plica can produce symptoms and signs similar to medial meniscal lesion, statistical analysis clearly demonstrated that giving way, locking, medial joint line tenderness and positive McMurray test were more commonly detected in Group B (p < 0.05). The sensitivity of detecting either one or more than one symptom or sign included in this study was higher in group B (89.5%), but a positive symptom or sign was more predictive in Group A (39.2%). Considering the variation of prevalence of medial patellar plica in other regions, the results from this study indicate that giving way, locking, clicking, medial joint line tenderness and positive McMurray test would be more predictive of medial patellar plica and thus clinical diagnosis of medial meniscal lesion might be affected if the prevalence of isolated medial patellar plica exceeded 16.6 per cent.

Artroscopia plicas / Artroscopy of plicas

El presente estudio de caracter retrospectivo, llevado a cabo en el Hospital San Juan de Dios de Bogota, sobre 48 procedimientos artroscopicos, realizados en igual numero de pacientes y fundamentalmente dirigidos a diagnostico endoscopico de problemas cronicos de rodilla. De otra parte, el estudio extendio su interes a las plicas como elementos sintomaticos, y su hallazgo esyadistico y patogenico, del 6.5%, motivo la iniciacion de un estudio retrospectivo de esta entidad. La edad promedio fue de 26.7 anos. El minimo se 15 y el maximo de 50 anos. 8 pacientes se beneficiaron con procedimientos minimos operatorios a traves del artroscopio. La comparacion entre el diagnostico de presuncion y el hallazgo artroscopico, arrojo tan solo un 22.9%de aciertos en el diagnostico clinico y correspondieron a 11 pacientes. Cinco pacientes no presentaron hallazgos. No se presentaron complicaciones importantes, no hubo infeccion en ninguno de los casos, el promedio de seguimiento de los pacientes fue de 8 semanas y asistieron al control 81.25%de los mismos (39 pacientes). 6 de los pacientes sometidos a atroscopia, quienes presentaban caracteristicas clinicas de Sindrome de Plica, fueron sometidos a artrografia previa por la tecnica de Aprin y Shapiro, con el fin de encontrar bandas fibroticas sinoviales sintomaticas. De estas 6 artrografias, 3 fueron positivas para plicas, pero tan solo 2 probaron ser sintomaticas, dadas sus caracteristicas anatomopatologicas y la mejoria presentada por estos pacientes tras la escion quirurgica. Con el presente estudio tan solo hemos querido comprobar una vez mas la utilizacion del procedimiento en los...