The effects of medial synovial plica excision with and without lateral retinacular release on adolescents with anterior knee pain

Clinical Management of Medial Patellar Plica Syndrome: Mini Review from Diagnosis to Treatment

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Synovial plicae are thickenings of the synovial knee membrane; they are very frequent and often asymptomatic. However, they can become symptomatic due to idiopathic or secondary causes, like trauma and inflammation of the synovial tissue. Currently, synovial plicae are classified as infrapatellar, mediopatellar and suprapatellar. The prevalence of the mediopatellar plica over the other forms of plicae varies between 18% and 60%. The most reported symptom of the mediopatellar plica is pain located medial to the patella above the joint line. Magnetic Resonance Imaging (MRI) is the most useful examination to highlight the presence of the plica, its measurement and exact location. The treatment is initially conservative, i.e. medical treatment and physiotherapy, however when these fail, the plica should be removed surgically via arthroscopy.

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In the current paper, we aim to report our clinical experience in the management of medial patellar plica syndrome by describing the clinical presentation and diagnosis of this condition as well as its treatment.

Management of suprapatellar synovial plica, a common cause of anterior knee pain: a clinical review

BACKGROUND AND AIM OF THE WORK

Suprapatellar synovial plica is caused by a congenital thickening of the synovial membrane and is generally asymptomatic. In the literature, suprapatellar plicae are described as one of the causes of anterior knee pain however, their real role in determining symptoms is controversial. The aim of the current paper is to describe the anatomy, classifications, pathophysiology, symptoms and management of suprapatellar plica syndrome, as well as the differential diagnosis from other causes of anterior knee pain.

METHOD

Via a search within the MEDLINE/PubMed database, a current review was conducted, and the results summarized.

RESULTS

Due to idiopathic, traumatic or inflammatory conditions, plicae can become pathological, causing anterior knee pain with possible knee clicking, swelling, giving way and locking after prolonged flexion of the knee. The diagnosis should be formulated based on an accurate medical history and clinical examination, followed by an appropriate imaging study. However, arthroscopy remains the "golden standard" for detecting all synovial plica.

CONCLUSIONS

In patients with anterior knee pain, where doubt is present in the imaging investigation for intraarticular or periarticular lesions, pathological suprapatellar synovial plica must be suspected. The treatment should initially be conservative, but in cases where symptoms persist, patients should undergo arthroscopy to confirm diagnosis and to determine a suitable treatment. In the presence of pathological plica associated with cartilage damage of the femoral condyle or patella at the time of diagnostic arthroscopy, plicae excision leads to favourable results in a high number of cases.