SYNOVIAL PLICAE OF THE KNEE JOINT: CLINICAL AND ARTHROSCOPIC CHARACTERISTICS AND SURGICAL TREATMENT
TL;DR
Symptomatic synovial plica of the knee is clinically relevant and is associated with frequent mechanical symptoms and concomitant intra-articular lesions, thereby supporting an individualized surgical strategy.
Abstract
Introduction. Synovial plicae of the knee are usually anatomical remnants of the synovial membrane; however, after trauma, repetitive overload, inflammation or fibrotic remodeling they may become a source of anteromedial knee pain and mechanical symptoms. The clinical presentation is often nonspecific and may imitate meniscal tears, chondral lesions, patellofemoral pain syndrome or ligamentous instability.Aim. To determine the clinical manifestations and arthroscopic variants of knee synovial plicae, the frequency of concomitant intra-articular lesions, and the structure of surgical treatment in patients undergoing arthroscopic knee surgery.Materials and methods. A single-center retrospective clinical and arthroscopic study included 350 patients with traumatic and degenerative knee disorders treated by arthroscopic techniques. We analyzed complaints, special clinical tests, magnetic resonance imaging data, plica morphology, meniscal and cruciate ligament injuries, cartilage status according to Outerbridge, and the type of surgery performed. Descriptive statistics were used.Results. The study group included 213 men and 137 women. In the subgroup with complete demographic data, the mean age was 44.5 ± 12.3 years. Pain and limitation of motion were reported by all patients; clicking was noted in 329 (94.0%), painful crepitus in 188 (53.7%), a rolling sensation in 107 (30.6%), and instability in 79 (22.6%) cases. The mediopatellar plica test was positive in 332 (94.9%) patients. Arthroscopy showed that the complete type was the most frequent mediopatellar plica variant, observed in 204 (58.3%) cases. Medial meniscus injury was detected in 253 (72.3%) patients and anterior cruciate ligament injury in 90 (25.7%). Chondral changes according to Outerbridge were found in 309 (88.3%) patients; grades II and III were the most common, with 104 (29.7%) cases each. Resection of the mediopatellar plica was performed in 252 (72.0%) patients, medial meniscus resection in 229 (65.4%), and anterior cruciate ligament reconstruction in 73 (20.9%).Conclusions. Symptomatic synovial plica of the knee is clinically relevant and is associated with frequent mechanical symptoms and concomitant intra-articular lesions. Arthroscopy verifies the plica type, cartilage status and associated pathology, thereby supporting an individualized surgical strategy.