Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2008; 75(5):369-374 | DOI: 10.55095/achot2008/066

Results of Resection of Medial Patellar Plica through a Supero-lateral Portal as a Main Arthroscopic ProcedureOriginal papers

P. JEMELIK^1,*, A. E. STROVER², G. EVANS³

¹ Research Fellow at London Knee Clinic, London Bridge Hospital Trauma and Orthopaedic Dept, Silesian Hospital Opava

² Droitwich and London Knee Clinic, England

³ London Knee Clinic, England

PURPOSE OF THE STUDY:
The aim of this study was to evaluate the results of resection of Medial Patellar Plica of the knee. The criteria for inclusion was that resection of the Medial Patellar Plica was the main arthroscopic intervention performed.

MATERIAL:
From 1^st January 2002 to 31^st December 2006, 1408 arthroscopies of the knee were carried out at the London Knee Clinic, London Bridge Hospital without the use of a tourniquet. In all cases of Medial Patellar Plica the Plica was observed through a supero-lateral portal as well as the standard portals. 53 knees fulfilled the criteria, of which 35 knees were traced and included in the study with an average follow-up period of 23.7 months. Typically patients were between the ages of 20-30 and engaged in sporting activities.

METHODS:
Age, sex, symptoms (onset and duration), VAS (Visual Analogue pain Scale from 1 to 10) before and after operation, return to sporting activity and patient's subjective evaluation of the result were recorded in 31 patients (35 knees).

RESULTS:
The average period of symptom duration prior to the operation was 18.6 months (minimum 2 months). The mean follow-up period was 23.7 months from operation (8-67 months), average VAS score was 6 points before surgery, and 2 points after surgery (0 - no pain, 10 excruciating pain). Mean improvement was 4 points. 34 % of patients were totally pain free after arthroscopic resection (0 point on VAS). 65.8% returned to the same level of sporting activity as occurred before the onset of knee problems. When asked whether they would undergo the same procedure on the other knee 72 % replied positively.

DISCUSSION:
Despite numerous publications about knee Plicae describing their anatomical and patho-physiological characteristics, there are still some arthroscopists who do not believe in their significance as a pathological entity and the diagnosis of Plica Syndrome remains controversial. The success of arthroscopic resection of one or more Plicae in most previous studies is rated on the scale excellent, good, poor, and very poor. The present study focuses on the type of Plica which is most frequently pathological, that is the Medial Patellar Plica and evaluates the outcome of surgery in terms of VAS score, return to sporting activity and the patient's satisfaction with treatment.

CONCLUSION:
Plicae are common anatomical structures, which sometimes become symptomatic. When pathological, they can give rise to quite disabling patello-femoral symptoms as well as participating in the acceleration of arthritic changes. In order to evaluate the Medial Patellar Plica properly including its involvement in patello-femur disorders, it is essential to examine the knee through a supra-patellar portal and to undertake dynamic examination of the knee in various degrees of flexion and extension. Resection of pathological Medial Patellar Plica is a successful procedure giving good results in a majority of patients with return to sporting activities. In some cases however, symptoms persist at a lower intensity even after their resection so that the sporting activity has to be reduced in the long term.

Keywords: Plica syndrome, shelf syndrome, synovial membrane, Plica medio-patellaris, medial patellar Plica

Accepted: June 23, 2008; Published: October 1, 2008  Show citation