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Suprapatellar plica syndrome linked with complete septum type suprapatellar plicae
In a study of patients who had primary arthroscopy, investigators found patients with suprapatellar plica syndrome demonstrated complete septum type suprapatellar plicae.
Researchers identified 125 patients who underwent primary arthroscopy. Based on the Dandy classification, at least two orthopedic surgeons watched surgical videos and defined the type of plicae. Investigators considered suprapatellar plica syndrome when patients complained of anterior knee pain and localized tenderness above the suprapatellar pouch, MRI showed suprapatellar plica structure and suspicious pathologies were excluded. The relationship between primary disease type and type of plica was assessed.
Results showed meniscal and ACL injuries were the cause for most primary diseases. Based on the Dandy classification, 23 knees were classified as having absent plicae, 14 knees had complete septum and 88 knees were considered “other.” No significant relationship was seen between disease type and morphological characteristics of the plicae.
There were five patients with suprapatellar pain. Of these patients, two were diagnosed with intra-articular free body, one patient had synovitis combined osteoarthritis and two patients had suprapatellar plica syndrome with a complete septum. There were two patients who experienced knee symptom resolution after arthroscopic resection of the plica. – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.
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In this study by Akao and colleagues, the authors identified two patients with symptomatic suprapatellar plica syndrome from a series of 125 patients who underwent 223 knee arthroscopies during a 1-year period. In both cases, the plica was suspected clinically based on tenderness in the suprapatellar pouch. Using a previously described classification system from Dandy, 14 patients were identified with a complete suprapatellar plica. In these two patients, there were no other intraoperative pathologic findings and arthroscopic debridement of the plica resulted in symptom resolution.
The authors also present an overview of the literature and describe a comprehensive approach to clinical, radiographic and the arthroscopic diagnosis, classification and treatment. While it is important to remember that suprapatellar plicae are rarely symptomatic, this study also serves to remind clinicians of the diversity of pathologies that can sometimes cause anterior knee pain.
Department of orthopedic surgery
Johns Hopkins University