The synovial plicae in the knee joint article pdf available in saudi medical journal 2712. Medial plica syndrome of the knee rsna publications online. Nov 21, 2017 plica syndrome or synovial plica syndrome inflames the knee. Three such folds are found with regularity in the human knee. There are four plica in the knee including the suprapatellar, infrapatellar, medial patellar and lateral patellar.
Remaining of the embryological septo the synovial plica of the articulation of the knee is a fold in the internal face the synovia synovial membrane, which separates embryologically form the patella in three compartments, being initiated the reabsorption of this synovia from the 4th month of intrauterine life on, allowing the patella to be contained in a single cavity. This involution is incomplete in many individuals, and it has been estimated that 50% of the population has persistent plicae after birth, which can vary in shape and size. You may not embed one of our images on your web page without a link back to our site. They have been implicated in anterior knee pain and possibly in chondromalacia patellae although their role remains controversial 1,3. Physical examination of the knee ligaments revealed that the knee was stable and. Manual force is then applied to the inferomedial part of the patellofemoral joint with the. Synovial plicae are folds of synovium, thought to represent embryologic remnants. Ultrasound imaging for recalcitrant lateral elbow pain. The mediopatellar plica also known as the aoki ledge plica, s ynovialis patellaris, iino ban d, plica al aris, synovial shelf, or patellar meniscus. 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 superior plica also is referred to as plica synovialis suprapatellaris, suprapatellar plica, superomedial plica, or medial suprapatellar plica. Sonography has a limited role in the evaluation of synovial plicae because of its inherent asymptomatic and symptomatic synovial plicae of the knee joint. This is a condition relating to irritation, enlargement, or inflammation of the plica in the knee.
Treatment with a local injection into the plica and surrounding synovium of a steroid and a longacting local anesthetic was tested in a series of 30 patients to see if. Exploring synovial plica of the knee academy of clinical. The two latter terms 16 are likely to be a reminder of hughstons ideas and may cause confusion with the medial plica. This inflammation is typically caused by the plica being caught on the femur, or pinched between the femur and the patella. Synovial plica are folds of embryonic remnants of synovial membrane which, in the foetus, divide knee into three compartments. However, there are key characteristics that show up when a plica is present. Aug 29, 2018 the synovial plica is the inward folds of the synovial lining present in the knee joint capsule. The effects of medial synovial plica excision with and. The suprapatellar plica is a synovial fold present in the suprapatellar pouch of the knee joint in approximately 20% of the population. It is critical to have the patient relax which is usually in supine while palpating the medial synovial plica. Sep 12, 20 knee pain,arthritis and injured cartilage everything you need to know dr. Plica syndrome treatment focuses on decreasing inflammation of the synovial capsule. Mri confirms that the unusual appearance of the suprapatellar pouch of the knee on ultrasound is due to a complete suprapatella plica entrapping fluid, producing localized synovitis and distorting the quadriceps fat pad. Although four such folds have been defined, it is mainly the medial patellar plica which is implicated in carrying clinical significance as a potential cause of anteromedial knee pain.
For example, the superior plica is also known as the suprapatellar plica, plica synovialis suprapatellaris, superomedial plica, and medial suprapatellar plica. The synovial folds found along the medial border of the knee cap are known as synovial plica. Jun 15, 2018 as a result, there may be a causeeffect relationship between the synovial plica and development of chondromalacia patella. Asymptomatic and symptomatic synovial plicae of the knee. Its main function is to create synovial fluid which helps nourish and lubricate your joint. The radiohumeral synovial plica is a horizontal meniscoid fold projected into the elbow joint i. 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. There is minor central quadriceps insertional tendinosis. Medial plica irritation of the knee is a very common source of anterior knee pain. The continuing education activity in contemporary diagnostic radiology is intended for radiologists.
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. Synovial plica synovial plica are folds of embryonic remnants of synovial membrane which, in the foetus, divide knee into three compartments. Knee pain,arthritis and injured cartilage everything you need to know dr. Plicae are a common cause of anterior knee pain associated with episodic clicking in the knee. The synovial membrane secretes synovial fluid into the joint which helps in lubrication of the joints, shock absorption, and nutrient and waste transportation. Clinical management of medial patellar plica syndrome.
Patients commonly have pain on physical examination. Treatment of pathological synovial plicae of the knee ncbi. Fluid within the suprapatellar recess of the knee joint with synovial thickening and hypervascularity indicating synovitis. Asymptomatic and symptomatic synovial plicae of the knee joint. A synovial plica affected by such changes may bowstring across the femoral trochlea, causing impingement between the patella and femur in knee. This report describes the anatomy, pathophysiology, clinical, and radiographic findings, and treatment of the synovial plicae of the knee joint.
The plica synovialis suprapatellaris is also known as the suprapatellar plica or septum. This plica is one of the most common sources of knee pain in patients. Lateral synovial plicae clinical presentation youtube. Iontophoresis and phonophoresis have been utilized successfully against inflammation of. The synovial fluid is produced by the synovial sheath which may also become inflamed resulting in knee. Plica syndrome is a condition that occurs when a plica becomes irritated, enlarged, or inflamed. Your plica can catch during knee straightening and bending, when you experience blunt trauma, have altered knee motions, or have knee.
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. Early reports on synovial plicae date back as far as the 16th century, when andre vesalius a belgian physician and anatomist was the first to describe the infrapatellar plica. Anatomy and mr imaging appearances of synovial plicae of. The medial synovial plica will present as a ribbonlike fold of tissue under ones. Editing in process come back later for updated information. Axial a and sagittal, proton densityweighted, fatsaturated b mr images show a thin mediopatellar plica arrows. As arthroscopic techniques are applied more frequently to various joints, it should be expected that the diagnosis of plica syndrome will become more common. Its free border may appear sharp, thin, wavy or crenated in the normal state. A synovial plica is a shelflike membrane between the synovium of the patella and the. 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.
Synovial plica syndrome, as this condition is known, is a common cause of anterior knee pain in adolescents and athletes. The views expressed in this article are not necessarily those of orthopaedic opinion online or the author. Plica is a membrane in the lining of the kneejoint or continuation of the protective synovial capsule that divides the knee into separate sections during fetal development. Synovial plicae are detected most readily by diagnostic arthroscopy. Aetiology the condition is caused by catching of the synovial folds within the knee during bending. Apr 19, 2014 synovial plica syndrome or simply plica syndrome. The fibrotic changes in the joint can eventually lead to softening and degeneration of the cartilage at the patellofemoral complex. Whit ewing, md a plica synovialis is a membranous fold or ridge found in the synovial lining of a joint. Ucm malta ludes lugano campus, ucm malta ludes lugano campus, ctr centre of rehabilitation therapy, reggio emilia, department of nutrition and dietetics. Plicae essentially consist of mesenchymal tissue which is formed in the knee during the embryological phase of development. A 14yearold girl with an unremarkable medical history presented to the family medicine clinic with a 6month history of right knee pain episodic locking and anterior pain. Contemporary diagnostic radiology issn 01499009 is published biweekly by. A 19yearold man reports right knee pain despite conservative therapy. As a result, there may be a causeeffect relationship between the synovial plica and development of chondromalacia patella.
Schematic drawing shows the layered structure of the lateral elbow and the close anatomicalhistological correlation between the cet, lcl, and lateral synovial plica with a sort of common proximal insertional site. The synovial plica of the knee is formed during the embryogenic phase of development and begins to involute during the 12 th week of fetal life. Case report open access a double patellalike condition. 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. Unusual morphology of the fluid with the impression of a central septation and mass effect upon the superior aspect of the quadriceps fat pad. Synovial problems removal of painful plica the synovial membrane is found in joints like your knee and shoulder. This thin membrane surrounds the inner lining of your joint and may have folds and fringes. Mar 10, 2017 the medial suprapatellar plica of the knee is an intraarticular synovial fold on the medial aspect of the knee.
Synovial plicae are seen best on t2weighted mri, appearing as bands of low signal intensity within the high signal intensity joint. First, the care provider may prescribe a nonsteroidal antiinflammatory medication. Synovial plica syndrome explained credihealth blog. This injury results in irritation or inflammation of the fold, which is found along the inside border of the knee cap. They are common, present in 90% of arthroscopies 3. Synovial plica article about synovial plica by the free. Rocked my world acid refluxhiatal herniagerd patient from boston duration. Medial synovial plica irritation anterior knee pain. Plica syndrome is a pathologic process due to inflammation of synovial plicae.
It has also been called the superomedial plica, a term referring to the frequent location of this synovial fold along the medial side of the suprapatellar pouch. Therapeutic exercise and modalities may also be used to treat the plica. Treatment of pathological synovial plicae of the knee. Synovial plica are folds within the fibrous membrane that eventually dissolve into the joint capsule of the knee. The medial suprapatellar plica of the knee is an intraarticular synovial fold on the medial aspect of the knee. Pdf imaging appearances of synovial plicae syndrome of. The term synovial plica has been devised to describe a number of intracapsular folds thought to represent remnants of a membranous knee joint partition present during foetal development. Anatomy and mr imaging appearances of synovial plicae of the knee. Sep 17, 2019 intense power doppler signal located in the deep planes white arrow at the level of the lcl and synovial fringe e. Summary synovial plicae represent inward folds of the synovial lining of the knee. Identifying the presence of a synovial plica is not easy because it can be so easily ascribed to some other pathology.
Nov 27, 2007 medial plica irritation of the knee is a very common source of anterior knee pain. This tissue forms membranes which divide the knee into 3 compartments. Article information, pdf download for lateral synovial plica syndrome open epub for. Treatment for plica syndrome should focus on decreasing the inflammation of the synovial capsule. The common region where the plica is present is the inside border of kneecap. The superior extent of the synovial abnormality has not been. Asymptomatic synovial plicae may be found normally within the knee. A synovial plica is a shelflike membrane between the synovium of the patella and the tibiofemoral joint. Pdf imaging appearances of synovial plicae syndrome of the knee. Characteristics of medial plica syndrome complicated with cartilage damage. Synovial plica irritationsymptomspreventiontreatmentpt. Full text plica syndrome and its embryological origins. If you would like a large, unwatermarked image for your web page or blog, please purchase the appropriate license. Dear editor, lateral elbow pain is commonplace in clinical practice.
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