DOI: https://doi.org/10.15674/0030-59872019496-105

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

Elena Baburkina

Abstract


The problem of diagnosis and treatment of the mediopatellar plica (MP) syndrome is urgent, since the pathology of this formation has not been studied sufficiently in adults, children and adolescents. MP syndrome causes pain in the anterior knee joint in 3.25–11 % of cases. The average frequency in adult population varies from 20 to 60 %. At arthroscopy intervention, the MP was detected in 14–100 % of patients, and 25–34 % of cases were found during autopsy of the dead bodies. At normal conditions the MP is thin, corneal and flexible. In the case of an in­flammatory process in the joint, it becomes swollen, thickened and affects the movement in the patella-femoral joint, determining changes in the cartilage of the knee and medial surface of the femur. In pathological MP, usually increases vascularization, it is noted hyalinization and signs of inflammation. Chronic cases of MP syndrome are characterized by fibro-cartilage metaplasia, progression of collagenosis and calcification. The most common is the classification by J. Sakakibara based on the size of the MP. Type A and B plicae are not always accompanied by symptoms; types C and D can be sandwiched between the medial growth and the knee and become thickened causing internal damage to the knee joint. The complexity of the diagnosis is due to the fact that clinical manifestations often mimic the symptoms of damage of the meniscus and ligaments. Pathology of MP is not different from the clinic of other knee injuries, except for the clear localization of pain, which is abruptly exacerbated during bending of the knee joint in the range from 150° to 110° and accompanied by a feeling of clicking. The most informative non-invasive methods of diagnosis of MP syndrome are ultrasound and MRI. For the treatment conservative and surgical methods are used. There are a small number of papers in which the authors describe the relationship between patello-femoral joint dysplasia and the presence of MP. In our opinion, the study of this issue is noteworthy. This will help to understand the causes of the syndrome, diagnosis and treatment tactics.


Keywords


knee joint; anterior knee pain; diagnosis; treatment

References


García-Valtuille, R., Abascal, F., Cerezal, L., García-Valtuille, A., Pereda, T., Canga, A., & Cruz, A. (2002). Anatomy and MR Imaging appearances of synovial plicae of the knee. RadioGraphics, 22 (4), 775–784. doi: 10.1148/radiographics.22.4.g02jl03775

Verdonk, R., Rombouts, J., Van Vynckt, C., Uyttendaele, D., & Claessens, H. (1982). Medial plica synovialis or shelf syndrome of the knee. Acta orthopaedica Belgica, 48 (3), 463–467.

Hardaker, W. T., Whipple, T. L., & Bassett, F. H. (1980). Diagnosis and treatment of the plica syndrome of the knee. The Journal of Bone & Joint Surgery, 62 (2), 221–225. doi: 10.2106/00004623-198062020-00008

Harrewyn, J. M., Aignan, M., & Delbarre, F. (1982). Les brides synovialis du genou [In French]. Rev du Rhumatisme, 49, 3–9.

Shubin Stein, B. E., & Strickland, S. M. (2019). Patellofemoral Pain and Instability. Springer International Publishing. doi: 10.1007/978-3-319-97640-2.

Richmond, J. C., & McGinty, J. B. (1983). Segmental arthroscopic resection of the hypertrophic mediopatellar plica. Clinical Orthopaedics and Related Research, &NA; (178), 185–189. doi: 10.1097/00003086-198309000-00021

Nottage, W. M., Sprague, N. F., Auerbach, B. J., & Shahriaree, H. (1983). The medial patellar plica syndrome. The American Journal of Sports Medicine, 11 (4), 211–214. doi: 10.1177/036354658301100405

Vaughan-Lane, T., & Dandy, D. J. (1982). The synovial shelf syndrome. The Journal of Bone and Joint Surgery. British volume, 64 (4), 475–476.

Griffith, C. J., & LaPrade, R. F. (2008). Medial plica irritation: diagnosis and treatment. Current Reviews in Musculoskeletal Medicine, 1 (1), 53–60. doi: 10.1007/s12178-007-9006-z

Tifford, C. D., & Jackson, D. W. (2003). Surgical management of the pathological plica. In D. W. Jackson (Ed.), Master techniques in orthopaedic surgery: reconstructive knee surgery. Philadelphia : Lippincott Williams & Wilkins.

Jackson, R. W. , Marshall, D. J., & Fujisawa, Y. (1982). The pathologic medical shelf. The Orthopedic Clinics of North America, 13 (2), 307–312.

Dandy, D. J. (1986). Arthroscopy in the treatment of young patients with anterior knee pain. Orthopedic Clinics of North America, 17 (2), 221–229.

Mayeda, T. U. (1918). Uber das strangartige Gebilde inder Kniegelenkhole (chorda cavi articularis genu) [In German]. Mitteilungen aus der Medizinschen Fakultat der Kaiserlichen Universitat zu Tokio, 21, 507–553.

Ewing, J. W. (1993). Plica: pathologic or not? The Journal of the American Academy of Orthopaedic Surgeons, 1 (2), 117–121.

Miller, H. (1981). Incarcerating mediopatellar synovial plica syndrome. Acta Orthopaedica Scandinavica, 52 (3), 357–361. doi: 10.3109/17453678109050115.

Kinnard, P., & Levesque, R. Y. (1984). The plica syndrome. A syndrome of controversy. Clinical Orthopaedics and Related Research, 183, 141–143. doi: 10.1097/00003086-198403000-00022.

Sung-Jae, Kim (2006). Patella plica syndrome. Anterior Knee Pain and Patellar Instability. Ed. Vicente Sanchis-Alfonso. Springer-Verlag London Limited.

Patel, D. (1986). Plica as a cause of anterior knee pain. Orthopedic Clinics of North America, 17 (2), 273–278.

Vaughan-Lane, T., & Dandy, D. J. (1982). The synovial shelf syndrome. Journal of Bone and Joint Surgery. British volume, 64 (4), 475–476.

Lyu, S. R., & Hsu, C. C. (2006). Medial plicae and degeneration of the medial femoral condyle. Arthroscopy, 22 (1), 17–26. doi: 10.1016/j.arthro.2005.08.039.

Johnson, D. P., Eastwood, D. M., & Witherow, P. J. (1993). Symptomatic synovial plicae of the knee. The Journal of Bone and Joint Surgery. American volume, 75 (10), 1485–1496. doi: 10.2106/00004623-199310000-00009.

Klein, W. (1983). The medial shelf of the knee. A follow-up study. Archives of Orthopaedic and Traumatic Surgery, 102 (2), 67–72. doi: 10.1007/bf02498717.

Broom M. J., & Fulkerson, J. P. (1986). The plica syndrome: a new perspective. The Orthopedic Clinics of North America, 17 (2), 279–281.

Dupont, J. Y. (1997). Synovial plicae of the knee. Controversies and review.Clinics in Sports Medicine, 16 (1), 87–122. doi: 10.1016/S0278- 5919(05)70009-0).

Dandy, D. J. (1990). Anatomy of the medial suprapatellar plica and medial synovial shelf. Arthroscopy, 6 (2), 79–85. doi: 10.1016/0749-8063(90)90002-u.

Boles, C. A., & Martin, D. F. (2001). Synovial plicae in the knee. American Journal of Roentgenology, 177 (1),221–227. doi: 10.2214/ajr.177.1.1770221.

Kim, S., & Choe, W. (1997). Arthroscopic findings of the synovial plicae of the knee. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 13 (1), 33–41. doi: 10.1016/s0749-8063(97)90207-3

Sakakibara, J. (1974). Arthroscopic study on Iino’s band (plica synovialis mediopatellaris). The Journal of the Japanese Clinical Orthopaedic Association, 50, 513–522.

Dorchak, J. D., Barrack, R. L., Kneisl, J. S., & Alexander, A. H. (1991). Arthroscopic treatment of symptomatic synovial plica of the knee. The American Journal of Sports Medicine, 19 (5), 503–507. doi: 10.1177/036354659101900515

Jee, W., Choe, B., Kim, J., Song, H., & Choi, K. (1998). The plica syndrome: diagnostic value of MRI with arthroscopic correlation. Journal of Computer Assisted Tomography, 22 (5), 814–818. doi: 10.1097/00004728-199809000-00028

Lee, Y. H., Song, H., Kim, S., Kim, S., & Suh, J. (2012). Infrapatellar plica of the knee: Revisited with MR arthrographies undertaken in the knee flexion position mimicking operative arthroscopic posture. European Journal of Radiology, 81 (10), 2783–2787. doi: 10.1016/j.ejrad.2011.12.028

Jouanin, T., Dupont, J. Y., Halimi, P., & Lassau, J. P. (1982). The synovial folds of the knee joint: Anatomical study. Anatomia Clinica, 4 (1), 47–53. doi: 10.1007/bf01811188

Hayashi, D., Xu, L., Guermazi, A., Kwoh, C. K., Hannon, M. J., Jarraya, M., & Roemer, F. W. (2013). Prevalence of MRI-detected mediopatellar plica in subjects with knee pain and the association with MRI-detected patellofemoral cartilage damage and bone marrow lesions: data from the Joints On Glucosamine study. BMC Musculoskeletal Disorders, 14 (1), 292. doi: 10.1186/1471-2474-14-292

Saengnipanthkul, S., Sirichativapee, W., Kowsuwon, W., & Rojviroj, S. (1992). The effects of medial patellar plica on clinical diagnosis of medial meniscal lesion. Journal of the Medical Association of Thailand, 75 (12), 704–708.

Silva E. A., Da Silva, A. P., Gomes, C. R. G. 2012. Morphophysiopathology of synovial plica from knee joint: a literature review. Journal of Morphological Sciences, 29 (2), 69–75.

Kent M., & Khanduja, V. (2010). Synovial plicae around the knee. Knee, 17 (2), 97–102. doi: 10.1016/j.knee.2009.07.009.

Amatuzzi, M. M., Fazzi, A., & Varella, M. H. (1990). Pathologic synovial plica of the knee. The American Journal of Sports Medicine, 18 (5), 466–469. doi: 10.1177/036354659001800503

Moises Cohen, Rene Jorge Abdalla, Antonio Altenor Bessa de Queiroz, & Ricardo Saone (1987). Estudo artroscуpico da prega sinovial sintomбtica do joelho. Revista Brasileira de Ortopedia, 22 (10), 293–296.

Rodríguez-Merchán, E. C., & Liddle, A. D. (2019). Disorders of the Patellofemoral Joint. Springer International Publishing.

Apple, J. S., Martinez, S., Hardaker, W. T., Daffner, R. H., & Genweiler, J. A. (1982). Synovial plicae of the knee. Skeletal Radiology, 7 (4), 251–254. doi: 10.1007/bf00361980

Internal Derangement of the Knee Joint due to Pathologic Synovial Folds. (1981). Clinical Orthopaedics and Related Research, &NA; (155), 59–64. doi:10.1097/00003086-198103000-00011

Shevtsov, V. I., Karaseva, T. Yu., Karasev, E.A., & Zagrebelnaya, O. N. (2008). Pathology of synovial folds of the knee joint: methods for diagnosis, treatment and rehabilitation of patients. Orthopedics genius, 3, 10–14. [in Russian]

Miller, H. (1981). Incarcerating mediopatellar synovial plica syndrome. Acta Orthopaedica Scandinavica, 52 (3), 357–361.

Rovere, G. D. (1985). Medial synovial shelf plica syndrome. Treatment by intraplical steroid injection. The American Journal of Sports Medicine, 13 (6), 382–386.

Conscious Neurosensory Mapping of the Internal Structures of the Human Knee Without Intraarticular Anesthesia. (1998). The American Journal of Sports Medicine, 26 (6), 773–777. doi: 10.1177/03635465980260060601

Dai, S. Y., Lin, D. X., He, T. Q., Li, H. Y., Meng, X. Y., Sun, B., & Zhong, S. Z. (1988). Synovial plica syndrome of the knee and related anatomy. Chinese Medical Journal, 101 (7), 529–532.

Barber, F. A. (1987). Fenestrated medial patella plica. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 3 (4), 253–257. doi: 10.1016/s0749-8063(87)80119-6

Nakayama, A., Sugita, T., Aizawa, T., Takahashi, & A., Honma, T. (2011). Incidence of Medial Plica in 3,889 Knee Joints in the Japanese Population. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 27 (11), 1523–1527. doi: 10.1016/j.arthro.2011.06.022

Sakakibara, J. O. (1976). Arthroscopic study on Iino’s band. The Journal of the Japanese Clinical Orthopaedic Association, 50, 513–522.

Akao, M., Ikemoto, T., Takata, T., Kitamoto, K., & Deie, M. (2019). Suprapatellar plica classification and suprapatellar plica syndrome. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 17, 10–15. doi: 10.1016/j.asmart.2019.03.001

Vassiou, K., Vlychou, M., Zibis, A., Nikolopoulou, A., Fezoulidis, I., & Arvanitis, D. (2014). Synovial plicae of the knee joint: the role of advanced MRI. Postgraduate Medical Journal, 91 (1071), 35–40. doi: 10.1136/postgradmedj-2013-132176

Lino, S. (1939). Normal arthroscopic findings of the knee joint in adult cadavers [In Japanese]. The Journal of the Japanese Clinical Orthopaedic Association, 14, 467–523.

Schindler, O. S. (2014). “The Sneaky Plica” revisited: morphology, pathophysiology and treatment of synovial plicae of the knee. Knee Surgery, Sports Traumatology, Arthroscopy, 22 (2), 247–262. doi: 10.1007/s00167-013-2368-4

Deutsch, A. L., Resnick, D., Dalinka, M. K., Gilula, L., Danzig, L., Guerra, J. Jr., & Dunn, F. H. (1981). Synovial plicae of the knee. Radiology, 141 (3), 627–634. doi: 10.1148/radiology.141.3.7302215.

Hughston, J. C., Whatley, G. S., Dodelin, R. A., & Stone, M. M. (1963). The role of the suprapatellar plica in internal derangement of the knee. The American Journal of Orthopedics, 5, 25–27.

Theut, P. C., & Fulkrson, J. P. (2003). Anterior knee pain and patellar subluxation in the adult. In J. C. DeLee, D. Drez, M. D. Miller. Orthopaedic Sports Medicine. Philadelphia : Saunders.

Gandolfi, M., Morselli, R., Pegreffi, P., & Armaroli, D. (1982). Sindrome della plica sinoviale clinica diagnosi terapia [In Italien]. La Chirurgia degli Organi di Movimento, 68, 603–613.

Chikvatiya, L. (2011). Pathological synovial folds of the knee joint in children and adolescents. Diagnosis and treatment: abstract of the dissertation of the candidate of medical sciences. Moscow.

Gerasimenko, M. A., Zhuk, E. V., & Tretyak, S. I. (2010). Synovial folds of the knee joint: classification, clinic, diagnosis and treatment. Medical journal, 4 (34), 105–109.

Kheiralla, O. A. M. (2016). Imaging appearances of synovial plicae syndrome of the knee. International Journal of Medical Research & Health Sciences, 5 (8), 140–149.

Klimenko, I. G. (2008). A method for diagnosing damage to the mediocellar fold — iino band. Siberian Medical Journal, 4, 95–98.

Bae, D., Nam, G. U., Sun, S. D., Kim, Y. H. (1998). The clinical significance of the complete type of suprapatellar membrane. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 14 (8), 830–835. doi: 10.1016/s0749-8063(98)70019-2

Schindler, O. S. (2004). Synovial plicae of the knee. Current Orthopaedics, 18 (3), 210–219. doi: 10.1016/j.cuor.2004.03.005

Boven, F., De Boeck, M., & Potvliege, R. (1983). Synovial plicae of the knee on computed tomography. Radiology, 147 (3), 805–809. doi: 10.1148/radiology.147.3.6844617

Bryukhanov, A. V., & Vasiliev, A. Yu. (2001). Magnetic resonance imaging in the diagnosis of joint diseases: Monograph. Barnaul. [in Russian]

Pitsyn, I. A. (2016). The use of arthroscopy and the principle of expert feedback to evaluate the true effectiveness of ultrasound in the differential diagnosis of pathology of intraarticular structures of the knee joint: the dissertation of the candidate of medical sciences. Yaroslavl. [in Russian]

Nakanishi, K., Inoue, M., Ishida, T., Murakami, T., Tsuda, K., Ikezoe, J., & Nakamura, H. (1996). Mr Evaluation of Mediopatellar Plica. Acta Radiologica, 37 (3P2), 567–571. doi: 10.1177/02841851960373p228

Vitko, N. K., Filisteev, P. A., & Morozov, S. P. (2013). Clinical significance and MR diagnostics of synovial folds of the knee joint (literature review). Medical Imaging, 4, 103–110.

Ren, A., Zheng, Z., Shang, Y., & Tian, C. (2012). An anatomical study of normal meniscal roots with isotropic 3D MRI at 3T. European Journal of Radiology, 81 (7), e783–e788. doi: 10.1016/j.ejrad.2012.03.015

Wong, S., Steinbach, L., Zhao, J., Stehling, C., Ma, C. B., & Link, T. M. (2009). Comparative study of imaging at 3.0 T versus 1.5 T of the knee. Skeletal radiology, 38 (8), 761–769. doi: 10.1007/ s00256-009-0683-0.

Kijowski, R., Blankenbaker, D. G., Davis, K. W., Shinki, K., Kaplan, L. D., & De Smet, A. A. (2009). Comparison of 1.5 and 3.0 T MR imaging for evaluating the articular cartilage of the knee joint. Radiology, (3), 839–848. doi: 10.1148/radiol.2503080822.

You, M., Park, J., Park, S., Jin, W., & Ryu, K. (2014). Posterior root of lateral meniscus: the detailed anatomic description on 3T MRI. Acta Radiologica, 55 (3), 359–365. doi: 10.1177/0284185113496677

Hopper, M. A., Grainger, A. J., & Robinson, P. (Eds.) (2010). Knee injuries. Essential radiology for sports medicine. New York: Springer.

Klimenko I. G. (2005). Method for the diagnosis of damage to the medial meniscus of the knee joint. Bulletin of the All-Russian Scientific Center of Medical Sciences, 6, 128. [in Russian]

Lyalina, V. V., & Shekhter, A. B. (2007). Arthroscopy and morphology of synovitis. Moscow: Nauka. [in Russian]

Ege G., Akman, H., & Ertem, E. (2002). Medial patellar plika sendromu. Tansal ve Giriflimsel Radyoloji, 8, 93–96.

Kochetkov, Yu. S., Popov, A.V., Ilyushenov, A.V., & Kochetkov, S. Yu. (2014). Arthroscopic method for treating shelf syndrome. Department of Traumatology and Orthopedics, Scientific and Practical Journal, 1 (9), 35–36.

Irismetov, M., Tadzhinazarov, M., Kholikov, A., Shamshimetov, D., & Usmonov, F. (2019). Endoscopic treatment of pathological medial patella plica syndrome of the knee. Genij Ortopedii, 25 (1), 38–41. doi: 10.18019/1028-4427-2019-25-1-38-41 [in Russian]

Dandy, D. J. (2000). Ortopedia e traumatologia pratica: diagnуstico e tratamento. Rio de Janeiro : Revinter.

Guney A., Kafadar, I., & Chen, Q. (Eds.) (2012). The Plica: Is a new aetiological factor in the knee osteoarthritis? Osteoarthritis — diagnosis, treatment and surgery. Croatia: IntechOpen.

Matsusue, Y., Yamamuro, T., Hama, H., Kuzuoka, K., Ueo, T., & Thomson, N. (1994). Symptomatic type D (separated) medical plica: Clinical features and surgical results. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 10 (3), 281–285. doi: 10.1016/s0749-8063(05)80112-4

Patel, D. (1978). Arthroscopy of the plicae – synovial folds and their significance. The American Journal of Sports Medicine, 6 (5), 217–225. doi: 10.1177/036354657800600502

Lee, P., Nixion, A., Chandratreya, A., & Murray, J. (2017). Synovial plica syndrome of the knee: a commonly overlooked cause of anterior knee pain. The Surgery Journal, 03 (01), e9–e16. doi: 10.1055/s-0037-1598047

Strover, A., Rouholamin, E., Guirguis, N., & Behdad, H. (1991). An arthroscopic technique of demonstrating the pathomechanics of the suprapatellar plica. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 7 (3), 308–310. doi: 10.1016/0749-8063(91)90133-i

Brief, L. P., & Laico, J. P. (1987). The superolateral approach: A better view of the medial patellar plica. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 3 (3), 170–172. doi: 10.1016/s0749-8063(87)80060-9

Koshino, T., & Okamoto, R. (1985). Resection of painful shelf (plica synovialis mediopatellaris) under arthroscopy. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 1 (2), 136–141. doi: 10.1016/s0749-8063(85)80045-1

Muse, G. L., Grana, W. A., & Hollingsworth, S. (2010). Arthroscopic treatment of medial shelf syndrome. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 26 (3), 391–392. doi: 10.1016/j.arthro.2009.12.024

Limbird, T. J. (1988). Patellar subluxation following plica resection. Orthopedic Reviews, 17 (3), 282–285.

Camanho, G. L. (2010). Treatment of pathological synovial plicae of the knee. Clinics, 65 (3), 247–250. doi: 10.1590/s1807-59322010000300002

Ogata, S., & Uhthoff, H. K. (1990). The development of synovial plicae in human knee joints: An embryologic study. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 6 (4), 315–321. doi: 10.1016/0749-8063(90)90063-j

Kurtoglu, Z., Zmansel, D., & Aktekin, M. (2010). The morphological features of the mediopatellar and lateral folds of the developing knee joint: a fetus cadaveric study. Acta Orthopaedica et Traumatologica Turcica, 229–234. doi: 10.3944/aott.2010.2236

Amatuzzi, M. M., Fazzi, A., Varella, M. H., & Dornelas, C. B. (1987). Plica Sinovial Patolуgica do Joelho: diagnуstico e resultado do tratamento conservador em 101 casos. Revista Brasileira de Ortopedia, 22 (1), 9–15.

Maffulli, N., Testa, V., & Capasso, G. (1993). Mediopatellar synovial plica of the knee in athletes. Medicine & Science in Sports & Exercise, 25 (9), 985–988. doi: 10.1249/00005768-199309000-00002

Tindel, N. L., & Nisonson, B. (1992). The plica syndrome. Orthopedic Clinics of North America, 23 (4), 613–618.




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