medial patellar plica syndrome

An acquired
plica-induced notch in the medial femoral condyle in a patient with medial patellar plica syndrome: a case report. Preoperative axial (a) and sagittal (b) proton density-weighted images showing medial patellar plica (white arrows). c Idiopathic groove is observed in the articular surface of the medial femoral condyle (white asterisk). d Postoperative axial proton density-weighted image after excision of the medial patellar plica
bmcmusculoskeletdisord.biomedcentral.com • CC-by-4.0
An acquired
plica-induced notch in the medial femoral condyle in a patient with medial patellar plica syndrome: a case report. Intraoperative arthroscopic views. a Medial patellar plica (MPP) with a tight and hypertrophic margin is observed, along with an abnormal notch in articular surface of the medial femoral condyle beneath the MPP (black asterisk). b The MPP runs downwards and merges with the synovial membrane covering the infrapatellar fat pad. c The MPP becomes impinged in the patellofemoral joint above an abnormal notch of the medial femoral condyle (black asterisk). d The MPP is excised with scissor forceps
bmcmusculoskeletdisord.biomedcentral.com • CC-by-4.0
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Medial patellar plica syndrome is one of the conditions that can be associated with the presence of synovial plicae of the knee (in this instance a medial plica). It can be a common source of anterior knee pain.

Epidemiology

While it can affect those of any age, it typically involves the young patients involved in repetitive athletic activity.

Clinical presentation

Patients may present with pain over the anteromedial aspect of the knees (mostly above the joint line ) and this may be accompanied by episodes of crepitation, catching, and pseudo-locking sensations.

Pathology

Knee plicae are synovial invaginations which are thought to be remnants of embryological development. Plicae ≥1 mm may be present in over 70% of individuals and are mostly asymptomatic . Under certain circumstances, they carry the potential to become inflamed and symptomatic. There can be fibrosis of a plica rendering it inflexible .

Radiographic features

Plain radiograph

Plicae are occult on plain radiograph.

MRI

Useful for identifying the presence of a plica and if it is thickened (typically appears like a shelf-like band). Signal characteristics of plicae are:

  • T1: low signal
  • T2/PD: low signal

In symptomatic patients, thickening of the medial plica and associated chondral defect of the medial patellar facet can be seen.

Treatment and prognosis

Management options range from the conservative end of rest - physiotherapy to corticosteroid injections to arthroscopic surgery.

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Assoziationen und Differentialdiagnosen zu Plica mediopatellaris-Syndrom: