Tratamiento por vía artroscópica de pacientes con el diagnóstico de plica sinovial de rodilla / Arthroscopic treatment of patients diagnosed with synovial knee plica / Tratamento artroscópico de pacientes diagnosticados com plica sinovial do joelho

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.

Anatomical and histological observation of ileocecal Treves fold and its clinical significance / 中华全科医师杂志

From December 2011 to August 2017,56 patients with acute abdomen surgery were treated in Affiliated Zhongshan Hospital of Dalian University.The anatomical structure of ileocecal Treves folds was observed during operation,and 15 samples of Treves folds were taken for histological examination.The mean length of the fold was (5.56±0.18)cm for males and (5.22±0.05)cm for female,the width was (1.82± 0.04) cm for males and (1.78 ± 0.06) cm for females;the thickness was (0.18 ± 0.02) cm.HE and verhoeff staining showed that Treves fold was mainly composed of elastic fiber,collagen fiber and smooth muscle with abundant blood supply.Thirty patients were repaired with their own Treves folds,including the fixation with overlay suture to the stump of appendectomy in 26 cases,repairing for perforation of colonic diverticulum in 3 case,and repairing for perforation of colonic diverticulum in 1 case.There were no complications such as fecal fistula,intestinal obstruction and intussusception after operation.The Treves fold has a constant location,which can be used as a clear sign of ileal terminal.It has abundant blood supply,and is suitable for the repair and reconstruction in ileocecal operation.

Diagnosis of a Snapping Elbow Caused by Hypertrophic Plica, Using Ultrasound / 대한정형외과학회잡지

This paper reports a case of a 21-year-old male patient who complained of intermittent pain and snapping at 110° of flexion in his left elbow joint. Magnetic resonance imaging revealed a band-like low signal intensity in front of the radiohumeral joint. An ultrasound was conducted to check its association with the symptoms. Observations of a high echo escaping from the radiohumeral joint at the point when snapping occurred indicated noted that the hypertrophic plica was a cause of the snapping. The hypertrophic plica removed arthroscopically, and the results were good for up to 6 months after surgery. If snapping is observed in the elbow joint, it will be necessary to consider the symptoms from the hypertrophic plica, although rare, and ultrasound might be an effective tool for a differential diagnosis.

Combination Surgery of Silicone Tube Intubation and Conjunctival Resection in Patients with Epiphora

PURPOSE: To compare the success rates of performing only silicone tube intubation versus carrying out both conjunctival resection and silicone tube intubation. METHODS: The subjects of this study involved 62 patients (96 eyes) between October 2015 and May 2017 who were diagnosed as having punctal stricture or nasolacrimal duct stenosis. Out of 96 eyes, 47 underwent only silicone tube intubation, and 49 underwent both silicone tube intubation and conjunctival resection. Three parameters were measured at 1, 3, and 6 months after the surgery: the area of the tear meniscus using RTVue-100 anterior segment optical coherence tomography, the height of the tear meniscus using a slit lamp microscope, and the subjective satisfaction of patients as a result of improved sympotms like epiphora. The surgery was considered successful when the patients' experienced the resolution of symptoms and reduction of the area and height of the tear meniscus. RESULTS: The area of the tear meniscus, height of the tear meniscus, and subjective satisfaction of patients was superior in the group that underwent both silicone tube intubation and conjunctival resection compared silicone tube intubation only. Based on these results, the success rate of the surgery was 68.9% in the group that underwent only silicone tube intubation and 78.7% in the group that underwent both silicone tube intubation and conjunctival resection. CONCLUSIONS: The resection of relaxed plica semilunares seems to increase the success rate of silicone tube intubation through the reduction of the area and height of the tear meniscus. Therefore, after determining the degree of conjunctivochalasis, if it was found to be severe, a combination with conjunctival resection was expected to increase the success rate of the surgery.

Arthroscopic Excision of Medial Knee Plica: A Meta-Analysis of Outcomes

PURPOSE: A meta-analysis was performed to assess the outcomes following surgical intervention for medial knee plica. MATERIALS AND METHODS: A literature search of Medline, EMBASE, CINAHL and Cochrane CENTRAL was performed using relevant key words. The primary outcome was patient-reported postoperative scores of “good” and “excellent”. Meta-analyses were performed using a random effects model. RESULTS: The literature search identified 731 articles. After removing duplicates and those not meeting the inclusion criteria, 12 articles reporting on a total of 643 knees were included for analysis, and of these, 7 articles including 235 knees were used for meta-analysis. The overall rate of good and excellent outcomes following surgery was estimated at 84.2% (95% confidence interval [CI], 72.8–91.4). In those cases that had non-surgical therapy prior to surgery, the rate of good and excellent outcomes of surgery was estimated at 76.1% (95% CI, 60.1–87). CONCLUSIONS: Arthroscopic surgical management of symptomatic medial knee plica results in favourable outcomes. Our results suggest that arthroscopic surgical excision should be considered as a treatment modality in patients with pathological medial plica disease of the knee either as a first-line treatment or when symptoms have not responded to non-surgical interventions. LEVEL OF EVIDENCE: IV

Comparison of MRI and arthroscopy in classification of mediopatellar plica and grading of cartilage injury in knee / 实用医学杂志

Objective To explore the MRI features in mediopatellar plica and cartilage injury.Methods The MRI appearances of 30 patients with mediopatellar plica were divided into four types and chondral injury were divided into five grades,then the characteristics of MRI imaging were analyzed,and compared with arthroscopy classification.Results The MRI manifestations of A type (n =7) of mediopatellar plica showed a cordlike elevation on the synovial wall;B type (n =13) showed shelf-like appearance but did not cover the anterior surface of the medial femoral condyle;C type (n =8) showed shelf-like appearance and covered the anterior surface of the medial femoral condyle and D type (n =2) showed a central defect in the mediopatellar plica.The MRI manifestations of chondral injury grades included zero grade (n =10),Ⅰ grade (n =2),Ⅱ grade (n =7),Ⅲ grade (n =7) and Ⅳ grade (n=4).There was no statistical significance in terms of classification of mediopatellar plica and grading of cartilage injury via MRI and arthroscopy.Conclusion MRI provides solid evidence for preoperative assessment and choice of operation scheme for classification of mediopatellar plica and grading of cartilage injury in knee.

Curative effect of mediopatellar plica syndrome under different therapies / 中国内镜杂志

Objective To compare and analyze the curative effects of mediopatellar plica syndrome under different therapies. Methods 147 patients with mediopatellar plica syndrome were enrolled in the study from January 2011 to January 2015 and divided into three groups refer to treatment: Group A, B and C. Each group was also divided in the youth group and the mid-age group. Different treatments were used in the three groups. Group A: drug therapy and physicotherapeutics; Group B: intraarticular injection regularly; Group C: arthroscopic surgical treatment. All patient conditions were assessed with Lysholm score. Results All patients received an average of 11 (9 ~ 13) months follow-up. No blood-vessel and nerve injured and infection occurred. Before receiving treatment, difference in Lysholm score of the three groups showed no statistical difference (F = 0.08, P = 0.926); after treatment, difference revealed significant difference (F = 15.48, P = 0.001). Compared with those before operation and after operation among the three groups, the Lysholm score was improved (tA = 3.43, tB = 6.74, tC = 7.99, P = 0.001). In the rangeability of Lysholm score, the Group C > B > A (F = 66.43, tAB = 5.97, tAC = 11.52, tBC = 5.55, P = 0.001);The general youth group > the general mid-age (t = 7.91, P = 0.001). Conclusion The best therapeutic method for mediopatellar plica syndrome is the arthroscopy. As for mid-age patients, it is necessary to inform them of possibility that prognosis is not well in preoperative planning.

Anatomical Study on the Relationship between the Infrapatellar Plica of Knee and the Femoral Insertion of Posterior Cruciate Ligament / 中国运动医学杂志

Objective To investigate the shape of the infrapatellar plica of the knee and its anatomical relationship with the femoral insertion of posterior cruciate ligament(PCL).Methods Thirteen fresh frozen adult cadaveric knee joints(6 left knees and 7 right knees) were dissected to explore the shape of the infrapatellar plica and its anatomical relationship with the femoral insertion of PCL.According to the HE staining,The junction of the femoral insertion of the infrapatellar plica and PCL was also observed using the hematoxylin-eosin staining.Results There was an infrapatellar plica in the knee,the anterior of which was connected to the fat pad.And then it passed the PCL at the lateral side,posteriorly connected to the middle part of the sagittal septum located between the anterior and posterior cruciate ligament.The posterior part of the sagittal septum formed the posterior septum of the knee.It was found that the infrapatellar plica could be classified into the complete type(membrane type) of 15.4％ (2/13),the incomplete type (separate type) of 76.9％ (10/13) and the absent type of 7.7％ (1/13) according to their morphologic characteristics.Moreover,the femoral insertion of the infrapatellar plica and the PCL was very close histologically.Conclusion The anatomical relationship between the infrapatellar plica of knee and the femoral insertion of PCL was very close in the anatomical structure.The infrapatellar plica is morphologically classified the complete type(membrane type),incomplete type(separate type) and absent type.

¿Es la artrosis de la rodilla, por fricción (plica), una realidad?: Análisis de esta patología degenerativa articular. Informe de un caso / Is the friction (medial plica) osteoarthritis of the knee, a reality?: Analysis of this joint degenerative pathology. A case report

La osteoartrosis de rodilla es la causa más común de dolor en el adulto mayor, se trata de una afección secundaria a diferentes patologías y afecta todas las estructuras intraarticulares. Un posible factor etiológico podría ser secundario a una plica medial inflamada y engrosada. Esta modalidad de patología no ha sido considerada en ninguna de las clasificaciones existentes y puede ser diagnosticada previamente, en la mayoría de los casos, mediante una resonancia magnética y confirmada por artroscopia. Los autores actualizan el tema y presentan un caso de artrosis del compartimiento medial de la rodilla secundaria a una plica medial.

Osteoarthritis of the knee is the most common cause of pain in the elderly; it is a condition secondary to various diseases and affects all intra articular structures. A possible etiologic factor could be secondary to medial plica inflamed and thickened. This type of pathology was not considered in any of the existing classifications and may be previously diagnosed, in most cases, by an MRI and confirmed by arthroscopy. The authors present a case of osteoarthritis of the medial compartment of the knee secondary to a medial plica and the theme is updated.

Diagnosis and treatment of medial plica syndrome of the knee by arthroscopy:Analysis of 46 cases / 医学研究生学报

Objective With the emerging omnipresence of arthroscopy, the plica syndrome has achieved a clinical recogni-tion as a pathological entity .This study is to investigate the clinical diagnosis and treatment of the medial plica syndrome of the knee . Methods We retrospectively analyzed 198 cases of medial plica syndrome, internal semilunar cartilage and chondromalacia patellae in the knee joints treated in our department from January 2008 to December 2011 .All the patients received physical and MRI examina-tions before admission and underwent plicaectomy, their knee function evaluated according to their Lysholm scores pre-and post-opera-tively. Results The diseased plica synovialis was completely excised in 46 cases diagnosed as simple medial plica syndrome by ar-throscopy.Forty-four of the patients were followed up for 6 to 32 (mean 26) months, and the excellence rate of treatment result was 95.5%. Conclusion Medial plica syndrome of the knee constitutes a larger proportion of knee disorders, for which arthroscopy re-mains the best diagnostic option and total excision of the diseased plica synovialis is an effective treatment .

Diagnosis and treatment of knee patellar plica under arthroscopy / 国际外科学杂志

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.

Morphophysiopathology of synovial plica from knee joint: a literature review

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.

Características clinicoepidemiológicas y endoscópicas de la plica sinovial en pacientes operados mediante artroscopia / Clinical, epidemiological and endoscopic characteristics of the synovial plica in patients with arthroscopy

Se realizó un estudio prospectivo de pacientes intervenidos quirúrgicamente de la rodilla mediante artroscopia en el Servicio de Reumatología, perteneciente al Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora de Santiago de Cuba durante los años 2000-2009; decenio en el cual fueron operadas 663 rodillas y, como muestra, 208 a causa de plica sinovial. Esta última resultó ser la enfermedad más frecuente, con primacía en el sexo femenino y las edades de 16 a 25 años. Hubo una marcada correspondencia clinicoartroscópica. Los diagnósticos preoperatorios estuvieron dados por lesión del menisco interno, condromalacia de rótula y sinovitis, por lo cual deben tenerse en cuenta como diagnosis diferencial en este síndrome. La forma de cicatrizar la sección quirúrgica de la plica sinovial es motivo de recidiva sintomática y reintervención quirúrgica, como ocurrió en 54,0 por ciento de los integrantes de la casuística, predominantemente atribuible a fibrosis en la zona de la herida.

A prospective study of patients with surgical treatment of the knee through arthroscopy was carried out at the Rheumatology Service, belonging to Saturnino Lora Teaching Clinical Surgical Provincial Hospital from Santiago de Cuba during the years 2000-2009; a decade in which 663 knees were surgically treated and, 208 due to a synovial plica. This last one turned out to be the most frequent disease, with predominance in the female sex and the ages from 16 to 25 years. There was a marked clinicoarthroscopic correspondence. Preoperative diagnosis consisted of lesion of the internal meniscus, chondromalacia patellae and synovitis, reason why they should be kept in mind as differential diagnosis in this syndrome. The way of healing the surgical section of the synovial plica is the cause of symptomatic relapse and surgical reintervention, as it happened in the patients of the case material 54,0 percent, mainly attributable to fibrosis in the wound area.

Arthroscopic Resection of Synovial Plica in Elbow

Purpose: To report our experience with nine cases of pathologic synovial plica on radiohumeral joint which symptom of painful snapping elbow was improved by arthroscopic resection. Materials and Methods: Between 1999 and 2004, 43 cases of elbow arthroscopy were performed by one surgeon. Eight patients with nine cases showed pathologic synovial plica in conjunction with snapping or posterolateral elbow pain. The mean age of eight patients (man: 7, woman: 1) was 29 years (range 16~56 years). All patients had a trial of conservative treatment at least six months (range 6~16 months). The diagnosis was confirmed before surgery in six cases and at the time of surgery in three cases. Pain, snapping, and subjective results were evaluated at least 12 months in the average (range 12~24). Results: All patients showed a hypertropic lateral synovial plica with local synovitis. Seven of them had an associated lesion of chondromalacia on radial head. One of them was associated with radiocapitellar arthritis and had a wrapping over the radial head. Six patients experienced improved posterolateral pain at the end of study (VAS<1). However, the other two patients had occasional pain with activity. One of them persisted with mechanical symptoms, which was treated with additional arthroscopic procedure. Conclusion: Synovial plica in elbow should be considered as an important entity of common elbow disease, especially when pain in the lateral aspect of the elbow with a snapping sensation during motion is featured in patients. The arthroscopic resection seems to be safe and efficient in the short and long term treatment of plica in the elbow joint.

Relationship between mediopatellar plica and chondral injury of medial femoral condyle / 中国矫形外科杂志

[Objective]To study the relationship between the existence and types of mediopatellar plica versus the chondral injury of the medial femoral condyle.[Method]Data were collected retrospectively from the photographic recording of arthroscopies performed from January 2004 to July 2008.Seventy-six knees were found with mediopatellar plica as the study group.Modified Sakakibara classification and the chondral injury(using the Outerbridge classification) of medial femoral condyle were recorded.Eighty knees without mediopatellar plica were randomly collected as controls.The correlation of mediopatellar plica and the cartilage injury on the surface of the medial femoral condyle was investigated.[Result]Patients with mediopatellar plica had a significantly higher incidence rate(89.5%) of medial femoral condyle cartilage lesion,in comparison with patients without mediopatellar plica(61.3%)(P=0.001).In the study group,a 64.3% proportion of the group with Sakakibara A mediopatellar plica was found to have cartilage lesion in the medial femoral condyle.The proportion of the group with Sakakibara BCD mediopatellar plica was found to be 95.2%,significantly higher than that in first group(P=0.004).The severity of cartilage injury in the medial femoral condyle was positively correlated with patient age(r=0.271,P=0.019) and the severity of the pathologic change of the mediopatellar plica(r=0.611,P=0.000).[Conclusion]According to this observation,the cartilage injury in the medial femoral condyle is more commonly found in patients with mediopatellar plica knees.A shelf-like appearance of the medial plica can increase the incidence of the cartilage injury.The severity of cartilage injury was positively correlated with patient age and the severity of the pathologic change of the mediopatellar plica.

Symptomatic Lateral Patellar Plica : A Case Report / 대한정형외과학회잡지

The plica is a remnant of the synovial folds during the coalescence of three compartments of the knee at 8 weeks of fetal development. The plica are classified according to their corresponding anatomic sites of the knee, such as suprapatellar, medial patellar, infrapatellar and lateral patellar plica. The medial patellar plica is considered to be the one most likely to cause problems and has been well documented in the literature. However, there are very few reports of problems being caused by lateral plica. We encountered one case of pathologic lateral plica that was excised by arthroscopy. We report this case with a review of the relevant literature.

Expression of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1 in pathologic synovial plicae of the knee joint / 中国微创外科杂志

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.

Diagnosis and Arthroscopic Treatment of Symptomatic Medial Patellar Plica Syndrome of the Knee / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of physical examination and dynamic arthroscopy in the diagnosis and treatment of medial patellar plica syndrome which is likely to be overlooked. SUBJECTS AND METHODS: 23 cases diagnosed as medial patellar plica syndrome from August 1998 through December 1999 were evaluated. Diagnosis was made by a symptom of a pain and a click sound during knee flexion, a physical examination of mass palpation and dynamic arthroscopy. RESULT: A dynamic rotation test was an useful physical examination having 96% rate of sensitivity. The results of excellent and good cases were in 19 cases (83%) and there was no worsened case symptomatically after arthroscopic resection. Postoperative complications were 3 cases including incomplete excision (1 case), postoperative hemarthrosis (1 case) and medial meniscus instability due to incorrect arthroscopic technique (1 case). In patients younger than 30 year old, the result of arthroscopic excision was better than that in older ones. CONCLUSION: Careful physical examination with dynamic arthroscopy is a useful method to diagnose the medial patellar plica syndrome which is likely to be overlooked, and arthroscopic complete excision result in excellent results which is of benefit to fast rehabilitation.

Arthroscopic Excision of the Complete Type of Suprapatellar Plica

The suprapatellar plica is a remnant of the embryonic septum separating the suprapatellar pouch from the knee joint. Complete type of suprapatellar plica is rarely reported and its clinlical significance is controversial. The purpose of this study is to verify the complete type of suprapatellar plica as an important cause of anterior knee pain and to evaluate the clinical results after arthroscopic excisien of it. From September 1991 to April 1997, we studied prospectively 54 patients, 90 knees which were diagnosed as cornplete type of suprapatellar plica preoperatively. The mean age was 32 years (15-57 years) and sex distribution was 14 males and 40 females. For the preoperative diagnosis, we checked clinical symptom, past history, physical finding and plain X-ray routinely and performed bone scan, double contrast arthrogram and MRI, if necessary. All patients complained vague anterior knee pain at standing, sitting, stair climbing and exercise for long times. All 90 knees were examined arthroscopically. Among them, 80 knees had complete type of suprapatellar plica and remaining 10 knees had other findings. After all, positive predictive value of preoperative diagnosis for complete type of suprapatellar plica was 89%. Among 36 patients diagnosed as bilateral preoperatively, 33 patients(92%) were confirmed as bilateral in arthroscopic examination. After arthroscopic excision of plica, clinical results were total relief of pain in 19 knees(24%), improvement in 55 knees(69%), no change in 6 knees(7%) and none of worsening. In conclusion, complete type of suprapatellar plica should be considered as an important cause of anterior knee pain especially which is vague, intermittent and bilateral.

Synovial Plicae of the Knee on Arthroscopy and MRI / 대한정형외과학회잡지

The types of the synovial plicae were classified according to the classification of Kim and Choe(1997). The purpose of this study was to evaluate the diagnostic ability of MRI for synovial plicae. We retrospectively reviewed the MR findings of the knee in 95 cases of 91 patients. In all 95 cases, findings of arthroscopy and MR images were available. MRI was performed with a 1.5 Tesla Magnetom(Siemens) using a round surface coil. Pulse sequence were Tl weighted image(TR 650ms /TE 20ms) and T2 weighted image(TR 2000ms/TE 70ms). MR images could not show the infrapatella plicae and lateral plicae clearly, but some suprapatellar plicae were shown in T2 weighted MR images (37.5% of hole type, 80% of complete type, 26% of medial type). In 20(22%) of the 90 cases with medial patella plicae proved by arthroscopy, a low intensity band was shown above the medial condyle of the femur on T2 weighted MR images. These 20 cases included 3 of fenestra type, 9 of wide shelf type and 8 of medial shelf type. The low intensity band seen on T2-weighted MR images and its anatomical relation to the medial femoral condyle are helpful in diagnosing the presence of medial shelf type and wide shelf type of medial plicae.