synovial plicae of the knee - 무릎 굴곡 70-100도에서 대퇴사두근 건과 femoral trochlea사이에서 끼임.

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plica syndrome 임상에서 진단내리기가 쉽지 않다. 

Depending on their size and elasticity, suprapatellar plicae may impinge between the quadriceps tendon and femoral trochlea at 70 to 100 of knee flexion.

function을 어떻게 회복할 것인가라는 질문을 던지게 되면 

plica syndrome은 더욱더 중요한 개념으로 다가온다. 

Synovial Plicae.pdf

Synovial Plicae of the Knee ver4.pdf

Summary : Synovial plicae represent inward folds of the synovial lining of the knee joint capsule, which are considered vestiges of a membranous knee joint partition present during foetal development. Three such folds are found with egularity in the human knee, but most are asymptomatic and of little clinical consequence. Plicae are more commonly seen in young adults, and can be an important cause of anterior knee pain, presenting with a plethora of symptoms. Most patients give a history of blunt trauma or an increase in repetitive sporting activities, but any form of chronic or transient synovitis can cause the plica to lose its elasticity by becoming inflamed and thickened. Such changes can affect suprapatellar and medial para-patellar plicae, which may bowstring and impinge in the patello-femoral joint during flexion,

subsequently leading to localised chondromalacia. 

As the clinical picture is not well defined, a high degree of suspicion is required. MRI might be of value in the diagnostic

assessment. The clinical diagnosis, however, is one of exclusion, and other more common pathologies relating to antero-medial knee pain should be considered first. Arthroscopy remains the gold standard for treatment of pathological plicae, although intraplical injection and physiotherapy might be beneficial in patients with a short history of symptoms. Complete excision is recommended and provides satisfactory results especially if the plica represents the only intra-articular pathology.

Medial patellar plicae are reported to be present in 18.5–80% of knees. The reported incidence of suprapatellar plicae ranging from 9.1% to 55%, with a complete suprapatellar septum being present in 4–20% of knees. The infrapatellar plica is generally said to be the commonest and according to Wachtler found in 85% of knees, whilst a lateral para-patellar plica is extremely rare with an incidence well below 1%.

Depending on their size and elasticity, suprapatellar plicae may impinge between the quadriceps tendon and femoral trochlea at 70 to 100 of knee flexion. 

During knee flexion, a plica of more than 1 cm in width, might come into contact with the medial patellar facet, the medial femoral condyle, or even the outer edge of the medial meniscus. 

Microscopically, normal plicae consist of a lining of single or reduplicated synovial cells resting on a

stroma of connective tissue containing abundant small blood vessels and collagen fibres, but no

elastic fibres.

Figure 4 A right medial para-patellar plica viewed from the supero-lateral portal at different degrees of knee

flexion. At 201 (a) the plica bowstrings across the medial femoral condyle, and displaces into the medial gutter at

flexion angles beyond 451 (b). Note the already present degenerative changes affecting the underlying condylar

cartilage.

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