Synovial plicae are folds of synovial tissue, remnants of embryonic septae of the normal articular embryonic development. The mediopatellar plica, also known as the medial synovial shelf, plica synovialis mediopatellaris or plica alaris elongata, is a synovial fold representing an embryonic remnant from the developmental process of the synovial cavity formation in the knee 1. Medial synovial plica irritation treatment the literature suggests an emphasis on quadriceps strengthening quadriceps sets, slr, leg presses, minisquats, walking program, recumbent stationary bike, swimming and stretching the hamstrings because the medial synovial plica is attached to the genu artciularis and indirectly to the quadriceps at. We aimed to examine the frequency of mridetected mediopatellar plica and its crosssectional association with mridetected cartilage damage and bone marrow lesions bmls in the patellofemoral joint pfj in a cohort of subjects with. In a smal amount of individuals 212% the elbow plica surrounds the fullest extent of the radial dome that we could call on the whole the circumferential synovial fold. The effects of medial synovial plica excision with and without lateral retinacular release. It is distinct from the annular ligament but contiguous with the radiocapitellar joint capsule, which blends with the common extensor tendon imperceptibly and forms a single enthesis at the lateral epicondyle. Thin hypoechoic border arrow of plica echo was seen.
Four plica synovial folds are found in the knee, but only one seems to cause trouble. Out of a whole 340 arthroscopic operative procedures for the knee performed between january 1996 and december 2000, 52 were as a result of clinical suspect of medial synovial plica. Because the synovial membrane of the knee is large, in fact the largest synovial membrane in the body, it obtains. During embryonic development, the knee is initially divided into three separate compartments by synovial membranes. The mediopatellar plica, also known as the medial synovial shelf, plica synovialis mediopatellaris or plica alaris elongata, is a synovial fold representing an embryonic remnant from the developmental process of the synovial cavity formation in the knee. Metaanalysis of three further studies which reported their outcomes as excellent, good, fair, or poor showed that arthroscopic excision of medial knee plica resulted in a good or excellent outcome in an estimated 76.
Many authors caution that this diagnosis is overrated, in particular medial plica syndrome, and unnecessary plicas have been removed. The majority of medial knee plica identified during arthroscopy are thin and asymptomatic. Medial plica echo was defined as hyperechoic longitudinal zone white arrowheads sliding over anterior surface of medial femoral condyle black arrowheads toward hypoechoic patellar cartilage echo during dynamic examination. Prevalence of mridetected mediopatellar plica in subjects. Case report open access a double patellalike condition. Primary synovial chondromatosis is a rare, benign, proliferative cartilaginous lesion that can arise from the tendon sheath, bursa or joint synovial tissue 1,2. During the fetal stage you have three capsules, called the synovial plicae, that grow around the developing knee joint. The normal synovial folds are thin, pink, and pliable. It can be directly visualized by arthroscopy, but can also be evalu. The incidence of the circulartype fold varied from 2 % to 12%. There are many causes of knee pain, but yours could be the result of a small part of your knee called the plica knee plica and plica syndrome. This injury results in irritation or inflammation of the fold, which is found along the inside border of the knee cap.
It is formed from collagen fibers and a very thin mucous membrane with a smooth surface synovial skin that lines the inner surface of the joint capsule. The intermediate layer, or retinacular layer, is made up of the anteriorthird capsule, or retinaculum, and its condensations, and the iliopatellar ligament laterally, lying super. The radiohumeral synovial fold is a consistent anatomic structure formed by capsular tissue and is located on the proximal edge of the annular ligament 7, 9, 10. Your knee joint is surrounded by a fluidfilled capsule called the synovial membrane. Medial part of plica black arrowheads extends over medial femoral condyle mfc. Because a debrided synovial plica results in alleviation of symptoms in only about 6070% of cases, with some of the remaining patients actually having more pain after surgery, it is recommended that the synovial plica be debrided only if significant scar tissue is present in the plica or if shelf erosion is noted on the medial femoral condyle.
Pdf prevalence of mridetected mediopatellar plica in. This inflammation is typically caused by the plica being caught on the femur, or pinched between the femur and the patella. Elbow synovial fold syndrome is an uncommon entity that is often. Elbow synovial plicae, or folds, are septal remnants of this process 1, 8, 9. Plica syndrome of the knee is a constellation of signs and symptoms that occur secondary to injury or overuse. One of the four folds, the medial plica, sometimes gets irritated from an injury or if you overuse your knee. Your knee joint is surrounded by a fluidfilled capsule called the synovial membrane during the. Medial synovial plica irritation anterior knee pain. The medial synovial plica is a fibrous shelf of the synovial lining that is thought to be a residual of embryonic knee development and is present in up to 70 % of the population 4, 5.
It is critical to have the patient relax which is usually in supine while palpating the medial synovial plica. Synovial plica may be a rare source of anterior knee pain in adolescents, although the relationship between plica and anterior knee pain is controversial. Triangular medial plica echo white arrowheads surrounded by hypoechoic border contacting a hypoechoic patellar cartilage arrows. The synovial skin secretes a liquid mass, the socalled synovial. The plica is a fold in the membrane surrounding your knee joint. It is thought that a plica is a remnant strand of mesenchymal tissue persisting from the embryonic development of the knee cavity between 812 weeks of gestation. Maakt het mogelijk om pdfbestanden samen te voegen met een simpele drag anddrop interface. In our case, the operative and histopathological findings showed that the double patellalike condition was secondarily induced by synovial osteochondromatosis. The superior plica also is referred to as plica synovialis suprapatellaris, suprapatellar plica, superomedial plica, or medial suprapatellar plica.
Synovial plica are folds of embryonic remnants of synovial membrane which, in the foetus, divide knee into three compartments. Medial synovial plica irritation clinical presentation. The true duplication of the patella, which is called double patella, is extremely rare. Normal synovial plicae of the elbow embryonic development the elbow joint is formed by mesenchymal cavitation occurring in order at the radiohum eral site, the ulnohumeral region, and final ly the radioulnar site, all divided by synovial septa 3.
Knee synovitis is a condition where the synovial membrane, which lines and lubricates the knee joint, becomes inflamed. The mediopatellar plica is a synovial fold representing an embryonic remnant from the developmental process of the synovial cavity formation in the knee. Plica synovialis definition of plica synovialis by. Ta a ridge or projection of the synovial membrane of a joint extending toward or between the two articular surfaces. A double patellalike condition secondary to synovial. Sonogram of symptomatic right knee in 15yearold female subject. Case report open access a double patellalike condition secondary to synovial osteochondromatosis yoshiteru kajikawa, yuji arai, hisatake takamiya, tetsuo higuchi, gen mori, shinsuke morisaki and toshikazu kubo abstract to our knowledge, this is the first case of synovial osteochondromatosis in a patient presenting with a double. The effects of medial synovial plica excision with and. To our knowledge, this is the first case of synovial osteochondromatosis in a patient presenting with a double patellalike condition. Plica syndrome is a condition that occurs when a plica a vestigial extension of the protective synovial capsule of the knee becomes irritated, enlarged, or inflamed. Synovial plicae are well known causes of clinical symptoms in the knee joint, especially when these structures hypertrophy and become inflamed.
Ultrasoundguided pain interventions in the knee region. Plica is a fold of the mucous membrane that starts from the inner synovial membrane. This synovial plica is a normal elastic structure that can become inflamed and fibrosed and cause pain and chondral damage through normal knee range of motion. Workers compensation industrial commissions denial of.
Synovial plica syndrome sps occurs in the knee, when an otherwise normal structure becomes a source of pain due to injury or overuse. Generally it is located in the anterior region of the joint. Normal mr imaging anatomy of the knee saifuddin vohra, do, george arnold, md, shashin doshi, md, david marcantonio, md there are several keys to successfully interpreting. The two latter terms 16 are likely to be a reminder of hughstons ideas and may cause confusion with the medial plica.
Tenosynovial chondromatosis is an extraarticular version of articular synovial chondromatosis, and it. Sonogram in a 15yearold female subject with history of pain, occasional knee locking, and severe limitation of sporting activity for 2 years previous to test. The medial plica arises from the genuarticularis muscle proximally and passes over the medial femoral condyle to merge with the synovial lining of the joint capsule. All the large joints present in the body knee, hip and shoulder are synovial joints.
A plica is a fold in the thin tissue that lines your knee joint. Pain is the main symptom and it increases with physical activity. Arthroscopic treatment of symptomatic synovial plica of the knee. Aetiology the condition is caused by catching of the synovial folds within the knee during bending. Also known as the ligamentum mucosum, it is a normal anatomical structure and it represents remnants of synovial membranes from embryological development.
Synovial plica of the knee was first described by mayeda in. Medial synovial plica of the knee is not a common condition to be beared in mind as a first intention clinical diagnosis since it has been demonstrated in this trial that a low rate of suspicion between surgeons and residents is the rule. Bilateral lateral synovial plicae presentation, an uncommon condition. Plicae have no well known function and are usually asymptomatic. The vastus intermedius originates broadly on the anterior surface of, and parallels, the femoral shaft. See more ideas about knee pain, knee injury and knee problem. Synovial plica, sometimes referred to as patella plica, is an injury to the fold in the sheath that surrounds and produces the synovial fluid that lubricates the knee. It ranges from a cordlike appearance to that of a larger shelf structure30. The most common synovial plica of the elbow are the posterolateral radiohumeral synovial fold, seen in 86 to 98% of asymptomatic subjets, and the lateral olecranean synovial fold in 30%. Workers compensation industrial commissions denial of application. Plicae are a common cause of anterior knee pain associated with episodic clicking in the knee. It can be directly visualized by arthroscopy, but can also be evaluated noninvasively using conventional mri. It is the most common plica in the knee 5 and sometimes it can become symptomatic. Synovitis of the knee can be a result of other conditions like rheumatoid arthritis or gout.
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