Skip to main content
SpringerLink
Log in

Predictors for an unsuccessful conservative treatment of patients with medial patellar plica syndrome

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

In several cases persistent medial knee pain remains after conservative treatment in patients with medial patellar plica syndrome. In recent literature accepted criteria for surgical indication are lacking. In this retrospective study patients after conservative treatment were evaluated to identify predictors for an unsuccessful outcome.

Materials and methods

117 Patients with medial patellar plica syndrome between 2016 and 2019 were retrospectively evaluated. All patients received conservative treatment for three months. Surgery was indicated due to failed conservative treatment (n = 76) with persistent medial knee pain and restriction of activity after 3 months. Preoperative MRI analysis, Lysholm score, pain by the visual analog scale (VAS), postoperative sports participation (RTS) and Tegner activity score were collected at least 12 months after definite treatment. Statistical analysis was performed to evaluate differences between patients with successful and unsuccessful conservative treatment.

Results

There were significant differences in the clinical and radiological findings between patients with successful and unsuccessful conservative treatment. Patients with failed conservative treatment showed a significant larger diameter of the medial patellar plica (0.8 ± 0.3 mm vs. 1.6 ± 0.4 mm; p < 0.05) and a significant higher rate of contact of the plica to the adjacent cartilage. Furthermore, these patients reported a significant higher rate of medial knee pain from flexion to extension and snapping symptoms. At final follow-up the patient-reported outcome by means of Lysholm score (96.25 vs. 95.93), RTS (96.2% vs. 97%) and Tegner activity score (6.0 vs. 6.01) was excellent after conservative and surgical treatment. There were no statistical differences in the preoperative and postoperative outcomes between both.

Conclusions

The diameter of a medial patellar plica and contact of the plica to the retropatellar cartilage as well as clinical signs like persistent medial knee pain from flexion to extension with snapping symptoms might be predictors for an unsuccessful conservative treatment and the need for surgical intervention in patients with painful medial patellar plica syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Verdonk R, Rombouts J et al (1982) Medial plica synovialis or shelf syndrome of the knee. ActaOrthopBelg 48(3):463–467

    CAS  Google Scholar 

  2. Nottage WM, Sprague NF 3rd et al (1983) The medial patellar plica syndrome. Am J Sports Med 11(4):211–214

    Article  CAS  Google Scholar 

  3. Nakayama A et al (2011) Incidence of medial plica in 3,889 knee joints in the Japanese population. Arthroscopy 27(11):1523–1527. https://doi.org/10.1016/j.arthro.2011.06.022

    Article  PubMed  Google Scholar 

  4. Johnson DP, Eastwood DM, Witherow PJ (1993) Symptomatic synovial plicae of the knee. J Bone Joint Surg Am 75(10):1485–1496

    Article  CAS  Google Scholar 

  5. Bellary SS et al (2012) Medial plica syndrome: a review of the literature. ClinAnat 25(4):423–428. https://doi.org/10.1002/ca.21278

    Article  Google Scholar 

  6. Broukhim B, Fox JM et al (1979) The synovial shelf syndrome. ClinOrthopRelat Res 142:135–138

    Google Scholar 

  7. Stubbings NS (2014) Diagnostic test accuracy of clinical and radiological assessments for medial patella plica syndrome: a systematic review and meta-analysis. Knee 21:486–490

    Article  Google Scholar 

  8. Hufeland MA et al (2019) Symptomatic medial synovial plica of the knee joint: an underestimated pathology. Arch Orthop Trauma Surg 139(11):1625–1631. https://doi.org/10.1007/s00402-019-03249-w

    Article  PubMed  Google Scholar 

  9. Rovere GD, Adair DM (1985) Medial synovial shelf plica syndrome. Treatment by intraplical steroid injection. Am J Sports Med 13(6):382–386

    Article  CAS  Google Scholar 

  10. Amatuzzi MM, Fazzi A, Varella MH (1990) Pathologic synovial plica of the knee. Results of conservative treatment. Am J Sports Med 18(5):466–469

    Article  CAS  Google Scholar 

  11. Kölle T, Alt W, Wagner D (2020a) Effects of a 12-week home exercise therapy program on pain and neuromuscular activity in patients with patellofemoral pain syndrome. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03543-y

    Article  PubMed  Google Scholar 

  12. Kölle T, Alt W, Wagner D (2020b) Immediate effects of an elastic patellar brace on pain, neuromuscular activity and knee kinematics in subjects with patellofemoral pain. Arch Orthop Trauma Surg 140(7):905–912

    Article  Google Scholar 

  13. Schindler OS (2014) ‘The Sneaky Plica’ revisited: morphology, pathophysiology and treatment of synovial plicae of the knee. KneeSurg Sports TraumatolArthrosc 22(2):247–262. https://doi.org/10.1007/s00167-013-2368-4

    Article  Google Scholar 

  14. Paczesny L et al (2019) A 10-year follow-up on arthroscopic medial plica syndrome treatments with special. Cartilage 2019:1947603519892310. https://doi.org/10.1177/1947603519892310

    Article  Google Scholar 

  15. Lee PYF et al (2017) Synovial plica syndrome of the knee: a commonly overlooked cause of anterior knee. Surg J (N Y) 3(1):e9–e16. https://doi.org/10.1055/s-0037-1598047

    Article  Google Scholar 

  16. Kim S-J, Jeong J-H, Cheon YM, Ryu S-W (2004) MPP test in the diagnosis of medial patellar plica syndrome. Arthroscopy 20(10):1101–1103

    Article  Google Scholar 

  17. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150–154

    Article  CAS  Google Scholar 

  18. Briggs KK et al (2009) Lysholm score and Tegner activity level in individuals with normal knees. Am J Sports Med 37(5):898–901. https://doi.org/10.1177/0363546508330149

    Article  PubMed  Google Scholar 

  19. Kim SJ, Choe WS (1997) Arthroscopic findings of the synovial plicae of the knee. Arthroscopy 13(1):33–41

    Article  CAS  Google Scholar 

  20. Dorchak JD et al (1991) Arthroscopic treatment of symptomatic synovial plica of the knee: long-term. Am J Sports Med 19(5):503–507

    Article  CAS  Google Scholar 

  21. Muse GL, Grana WA, Hollingsworth S (1985) Arthroscopic treatment of medial shelf syndrome. Arthroscopy 1(1):63–67

    Article  CAS  Google Scholar 

Download references

Acknowledgements

None.

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Hessingstraße 17, 86199, Augsburg, Germany

    Fabian Blanke, Nicola Oehler, Hasan Al Aidarous & Stephan Vogt

  2. Department of Orthopedic Surgery, University Medical Center Rostock, Rostock, Germany

    Fabian Blanke, Thomas Tischer & Robert Lenz

Authors
  1. Fabian Blanke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicola Oehler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hasan Al Aidarous
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas Tischer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephan Vogt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert Lenz
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All six authors made substantial contributions to the conception, design, acquisition, analysis and interpretation of data for the work. Moreover, all authors took part in drafting the work and revising it critically for important intellectual content. All authors participated in the final approval of the version to be published and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Fabian Blanke.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all patients included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This study had been approved by the Institutional Board of our Hospital (Hessing Stiftung Augsburg, Germany, ID 092019).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Blanke, F., Oehler, N., Al Aidarous, H. et al. Predictors for an unsuccessful conservative treatment of patients with medial patellar plica syndrome. Arch Orthop Trauma Surg 141, 93–98 (2021). https://doi.org/10.1007/s00402-020-03646-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03646-6

Keywords

Search

Navigation